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Bleeding Lesion of the Small Bowel: an Extensive Update Leaving No Stone Unturned

  • Small Intestine (D Sachar, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Gastrointestinal bleeding originating from the small bowel (SB) poses a challenge to the treating gastroenterologist. Once diagnosed, management is not a walk in the park either. This review intends to summarize the current state-of-the-art evidence in a complete way with special attention for vascular and ulcerative lesions, to provide the reader with a clinical guide and flow chart towards SB bleeding.

Recent Findings

Absence of SB bleeding lesions on CE does not directly yield better prognosis; although having a lower rebleeding rate the first 2 years, rebleeding in the long term is high. Push enteroscopy can play an early role in patients with SB bleeding if suspicion of angioectasia is high, since these lesions tend to be located in the proximal SB. Endoscopic management of angioectasia is, however, difficult and shows poor results.

Summary

Capsule endoscopy (CE) or device-assisted enteroscopy (DAE) remain the diagnostic mainstay in SB bleeding, choosing one over the other based upon patient characteristics and expected lesions.

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Authors and Affiliations

  1. Department of Gastroenterology, Ghent University Hospital, De Pintelaan 185, 1K12, 9000, Ghent, Belgium

    Cedric Van de Bruaene, Pieter Hindryckx & Danny De Looze

  2. Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Laurens Van de Bruaene

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  1. Cedric Van de Bruaene
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Correspondence to Cedric Van de Bruaene.

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Danny De Looze, Cedric Van de Bruaene, and Laurens Van de Bruaene declare no conflict of interest.

Pieter Hindryckx reports receiving reimbursement for travel accommodations from Y-ECCO; personal fees from Abbvie, Takeda, and Janssen for work as a consultant; personal fees from Ferring as a lecturer; and is a board member of the Yount Flemisch Society of Gastroenterology.

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Van de Bruaene, C., Hindryckx, P., Van de Bruaene, L. et al. Bleeding Lesion of the Small Bowel: an Extensive Update Leaving No Stone Unturned. Curr Gastroenterol Rep 20, 5 (2018). https://doi.org/10.1007/s11894-018-0610-4

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