Mistakes in small bowel bleeding and how to avoid them

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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

Lau WY, et al. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin. Gut 1987; 28: 869–877. [Link]

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]

Gerson LB, et al. ACG Clinical Guideline: Diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110: 1265–1287. [Link]

Raju GS, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694–1696. [Link]

Gunjan D, et al. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf) 2014; 2: 262–275. [Link]

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]

Descamps C, et al. 'Missed' upper gastrointestinal tract lesions may explain 'occult' bleeding. Endoscopy 1999; 31: 452–425. [Link]

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]

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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Mistakes in inflammatory bowel disease and reproduction and how to avoid them

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lau WY, et al. Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin. Gut 1987; 28: 869–877. [Link]

Gerson LB, et al. ACG Clinical Guideline: Diagnosis and management of small bowel bleeding. Am J Gastroenterol 2015; 110: 1265–1287. [Link]

Raju GS, et al. American Gastroenterological Association (AGA) Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterology 2007; 133: 1694–1696. [Link]

Gunjan D, et al. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf) 2014; 2: 262–275. [Link]

Descamps C, et al. 'Missed' upper gastrointestinal tract lesions may explain 'occult' bleeding. Endoscopy 1999; 31: 452–425. [Link]

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.

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.

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.

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

Inflammatory bowel disease (IBD) is a chronic relapsing gastrointestinal disease, often affecting young people during their fertile years. The chronic character of IBD means that lifelong medical treatment is often required. As such, it is not surprising that questions often arise about fertility and pregnancy in patients with IBD. The most important risk factor for adverse pregnancy outcomes in IBD patients is the presence of disease activity during pregnancy. Indeed, negative pregnancy outcomes (e.g. spontaneous abortion, preterm delivery and low birth weight) are associated with disease activity at the time of conception and during pregnancy.

Topics

IBD Primary Care

Citation

Cite this article as: Kanis SL and van der Woude CJ. Mistakes in inflammatory bowel disease and reproduction and how to avoid them. UEG Education 2016: 16: 20–23.

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2024

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