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Le rôle de l’entéroscopie dans les saignements gastro-intestinaux occultes

The role of enteroscopy in gastrointestinal bleeding of obscure origin

  • Published:
Acta Endoscopica

Conclusion

Le rôle principal de l’entéroscopie est l’exploration des patients qui présentent un saignement gastrointestinal occulte. L’indication est posée après avoir réalisé dans des conditions satisfaisantes une exploration endoscopique négative du tractus digestif supérieur et du côlon.

L’entéroscopie poussée semble supérieure aux autres techniques en raison de la bonne tolérance de l’examen, de sa durée relativement courte et de l’appoint d’un canal opérateur et des performances vidéo-endoscopiques. L’entéroscopie fournit un score diagnostic élevé dans les anémies d’origine inconnue chez les patients qui ont été correctement sélectionnés.

Les lésions les plus souvent rencontrées sont les AD chez les patients âgés, et les tumeurs dans la population plus jeune. Le traitement de l’AD acquise demeure incertain. L’entéroscopie peut jouer un rôle majeur dans la compréhension de la physiopathologie de ces lésions en raison de la visualisation directe des anomalies vasculaires. Leur surveillance après l’un ou l’autre traitement, doit être réalisée au cours d’explorations consécutives. Contrairement aux AD acquises, les lésions associées à la maladie d’Osler-Weber-Rendu répondent de façon plus satisfaisante à l’hormonothérapie.

Conclusion

The major role of enteroscopy is evaluation of patients with obscure gastrointestinal bleeding. Enteroscopy may be considered after one negative upper and one negative total colonoscopy performed in satisfactory conditions.

Push-enteroscopy seems to be superior to former techniques because the examination is well tolerated, relatively short in duration and includes an operating channel and video capacities. Enteroscopy constitutes an endoscopic investigation of high diagnostic yield in anemias of unknown origin if the patients are selected adequately. The lesions which are the more likely to be found are AD in an elderly population and tumors in a younger population.

Treatment of acquired AD remains enigmatical. Yet enteroscopy may play a major role in understanding the pathophysiology of these lesions because direct visualisation of AD is possible. Thus follow-up of AD treated by one therapy or another may be performed by consecutive enteroscopies. Contrary to the acquired AD, Osler-Weber-Rendu related AD are more likely to respond satisfactorily to hormonal therapy.

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  1. Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgique

    A. Schmit & A. van Gossum

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Schmit, A., van Gossum, A. Le rôle de l’entéroscopie dans les saignements gastro-intestinaux occultes. Acta Endosc 26, 267–276 (1996). https://doi.org/10.1007/BF02963391

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