Role of Endoscopy in the Management of Suspected Small-Bowel Bleeding
Publication Date: January 1, 2017
Last Updated: March 14, 2022
Recommendations
For patients with signs or symptoms consistent with recurrent upper or lower GI sources of bleeding, we suggest repeating EGD and colonoscopy, respectively, before small-bowel evaluation. (⊕⊕oo)
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We suggest VCE as the initial test for patients with overt or occult small-bowel bleeding. Positive VCE results should be followed with push enteroscopy if within reach or DAE. (⊕⊕oo)
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We suggest DAE or push enteroscopy if VCE is unavailable or nondiagnostic in patients with overt small-bowel bleeding. (⊕⊕oo)
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We suggest that in select circumstances (eg, high level of suspicion of small-bowel angiectasias or in patients with surgically altered anatomy) DAE may be considered as the initial small-bowel diagnostic procedure in patients with small-bowel bleeding. (⊕⊕oo)
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We suggest that after an appropriate negative evaluation, clinically stable patients without recurrent bleeding may be treated with iron therapy and clinically followed if iron deficiency is present. (⊕⊕oo)
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We suggest multiphase CTE or MRE in patients with obscure bleeding and suspected small-bowel neoplasms. (⊕⊕⊕o)
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Following appropriate hemodynamic resuscitation, we recommend angiography for selective embolization in patients who present with hemodynamically unstable suspected small-bowel bleeding. (⊕⊕⊕o)
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We suggest a CTA or RBC scan for localization of the bleeding site and to guide timing of angiography in hemodynamically stable patients with suspected active small-bowel bleeding. (⊕⊕oo)
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Title
Role of Endoscopy in the Management of Suspected Small-Bowel Bleeding
Authoring Organization
American Society for Gastrointestinal Endoscopy
Publication Month/Year
January 1, 2017
Last Updated Month/Year
June 5, 2023
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Laboratory technician, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management
Diseases/Conditions (MeSH)
D016099 - Endoscopy, Gastrointestinal, D041742 - Upper Gastrointestinal Tract
Keywords
upper GI endoscopy, Overt small-bowel bleeding, Occult small-bowel bleeding, small-bowel bleeding
Source Citation
Gurudu, S. R., Bruining, D. H., Acosta, R. D., Eloubeidi, M. A., Faulx, A. L., Khashab, M. A., … DeWitt, J. M. (2017). The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointestinal Endoscopy, 85(1), 22–31. doi:10.1016/j.gie.2016.06.013