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Mistakes in small bowel bleeding and how to avoid them

Andrea Telese, Alberto Murino, Edward J Despott

Summary

AI Generated

This article addresses frequent mistakes in the investigation and management of small bowel bleeding and proposes strategies to avoid them, despite advances in imaging technologies over the past 17 years.

  • Small bowel sources account for 5–10% of all gastrointestinal bleeding cases
  • Technologies including small bowel capsule endoscopy, device-assisted enteroscopy, and dedicated cross-sectional imaging have transformed small bowel investigation over the past 17 years
  • Definitive management of small bowel bleeding remains challenging even with current advanced imaging
  • The material is most relevant for clinicians managing gastrointestinal bleeding cases
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Lau WY, et al. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin. Gut 1987; 28: 869–877. [Link]
2.
Pennazio M, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352–376. [Link]
3.
Gerson LB, et al. ACG Clinical Guideline: Diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110: 1265–1287. [Link]
4.
Raju GS, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694–1696. [Link]
5.
Gunjan D, et al. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf) 2014; 2: 262–275. [Link]
6.
Zaman A, et al. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc 1998; 47: 372–376. [Link]
7.
Descamps C, et al. 'Missed' upper gastrointestinal tract lesions may explain 'occult' bleeding. Endoscopy 1999; 31: 452–425. [Link]
8.
Lara LF, et al. The rate of lesions found within reach of esophagogastroduodenoscopy during push enteroscopy depends on the type of obscure gastrointestinal bleeding. Endoscopy 2005; 37: 745–750. [Link]
9.
Huprich JE, et al. Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology 2011; 260: 744–751. [Link]
10.
Shinozaki S, et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8: 151–158. [Link]
11.
Aniwan S, et al. Urgent double balloon endoscopy provides higher yields than non-urgent double balloon endoscopy in overt obscure gastrointestinal bleeding. Endosc Int Open 2014; 02: E90–E95. [Link]
12.
Singh A, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study. Gastrointest Endosc 2013; 77: 761–766. [Link]
13.
Yamada A, et al. Timing of capsule endoscopy influences the diagnosis and outcome in obscure-overt gastrointestinal bleeding. Hepatogastroenterol 2012; 59: 676–679.
14.
Monkemuller K, et al. A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding. Endoscopy 2009; 41: 715–717. [Link]
15.
Rondonotti E, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423–446. [Link]
16.
Sanaka MR, et al. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10: 910–916. [Link]
17.
Sanchez-Yague A, et al. The endoscopic cap that can (with videos). Gastrointest Endosc 2012; 76: 169–178.e2. [Link]
18.
Despott EJ and Murino A. Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection. Dig Liver Dis 2017; 49: 13. [Link]
19.
Gay G, et al. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy. Endoscopy 2006; 38: 49–58. [Link]
20.
Fry LC, et al. Capsule endoscopy increases the diagnostic yield of double balloon enteroscopy in patients being investigated for obscure gastrointestinal bleeding. Arch Gastroenterohepatol 2012; 29: 9–14.
21.
Yano T, et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008; 67: 169–172. [Link]
22.
Svarta S, et al. Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management . Canad J Gastroenterol 2010; 24: 441–444. [Link]
23.
Jones BH, et al. Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 1058–1064. [Link]
24.
Byeon JS, et al. Is a repeat double balloon endoscopy in the same direction useful in patients with recurrent obscure gastrointestinal bleeding? J Clin Gastroenterol 2013; 47: 496–500. [Link]
25.
Badr Al-Bawardy, et al. Outcomes of repeat balloon assisted enteroscopy in small-bowel bleeding. Endosc Int Open 2018; 6: E694–E699. [Link]
26.
Shinozaki S, et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8: 151–158. [Link]

Abstract

Over the past 17 years, the disruptive impact of technologies including small bowel capsule endoscopy (SBCE), device-assisted enteroscopy (DAE) and dedicated cross-sectional imaging has transformed the investigation and management of small bowel pathology. Although a small bowel source only accounts for 5–10% of all cases of gastrointestinal bleeding,definitive management of small bowel bleeding even in the current era of advanced imaging, can still pose formidable challenges. In this brief article, we highlight frequent mistakes made in the investigation and management of small bowel bleeding and discuss strategies for their avoidance.

Topics

Small Intestine & Nutrition

Citation

Despott EJ, Telese A and Murino A. Mistakes in small bowel bleeding and how to avoid them. UEG Education 2018; 18: 27–29.

Published

2024

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

Summary

AI Generated

Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

  • Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.

  • This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.

  • With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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UEG Mistakes In Articles
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Mistakes in the management of hepatocellular carcinoma and how to avoid them

Spyridon Pantzios, Ioannis Elefsiniotis, Christos Triantos

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Lau WY, et al. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin. Gut 1987; 28: 869–877. [Link]
2.
Pennazio M, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352–376. [Link]
3.
Gerson LB, et al. ACG Clinical Guideline: Diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110: 1265–1287. [Link]
4.
Raju GS, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694–1696. [Link]
5.
Gunjan D, et al. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf) 2014; 2: 262–275. [Link]
6.
Zaman A, et al. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc 1998; 47: 372–376. [Link]
7.
Descamps C, et al. 'Missed' upper gastrointestinal tract lesions may explain 'occult' bleeding. Endoscopy 1999; 31: 452–425. [Link]
8.
Lara LF, et al. The rate of lesions found within reach of esophagogastroduodenoscopy during push enteroscopy depends on the type of obscure gastrointestinal bleeding. Endoscopy 2005; 37: 745–750. [Link]
9.
Huprich JE, et al. Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology 2011; 260: 744–751. [Link]
10.
Shinozaki S, et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8: 151–158. [Link]
11.
Aniwan S, et al. Urgent double balloon endoscopy provides higher yields than non-urgent double balloon endoscopy in overt obscure gastrointestinal bleeding. Endosc Int Open 2014; 02: E90–E95. [Link]
12.
Singh A, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study. Gastrointest Endosc 2013; 77: 761–766. [Link]
13.
Yamada A, et al. Timing of capsule endoscopy influences the diagnosis and outcome in obscure-overt gastrointestinal bleeding. Hepatogastroenterol 2012; 59: 676–679.
14.
Monkemuller K, et al. A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding. Endoscopy 2009; 41: 715–717. [Link]
15.
Rondonotti E, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423–446. [Link]
16.
Sanaka MR, et al. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10: 910–916. [Link]
17.
Sanchez-Yague A, et al. The endoscopic cap that can (with videos). Gastrointest Endosc 2012; 76: 169–178.e2. [Link]
18.
Despott EJ and Murino A. Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection. Dig Liver Dis 2017; 49: 13. [Link]
19.
Gay G, et al. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy. Endoscopy 2006; 38: 49–58. [Link]
20.
Fry LC, et al. Capsule endoscopy increases the diagnostic yield of double balloon enteroscopy in patients being investigated for obscure gastrointestinal bleeding. Arch Gastroenterohepatol 2012; 29: 9–14.
21.
Yano T, et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008; 67: 169–172. [Link]
22.
Svarta S, et al. Diagnostic yield of repeat capsule endoscopy and the effect on subsequent patient management . Canad J Gastroenterol 2010; 24: 441–444. [Link]
23.
Jones BH, et al. Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2005; 100: 1058–1064. [Link]
24.
Byeon JS, et al. Is a repeat double balloon endoscopy in the same direction useful in patients with recurrent obscure gastrointestinal bleeding? J Clin Gastroenterol 2013; 47: 496–500. [Link]
25.
Badr Al-Bawardy, et al. Outcomes of repeat balloon assisted enteroscopy in small-bowel bleeding. Endosc Int Open 2018; 6: E694–E699. [Link]
26.
Shinozaki S, et al. Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy. Clin Gastroenterol Hepatol 2010; 8: 151–158. [Link]

Abstract

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

Topics

Digestive Oncology Hepatobiliary

Published

2026

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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

Sanjay Pandanaboyana

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Small Intestine & Nutrition

Published

2026

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

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IBD

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

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The global reference point for the digestive health community

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