Abstract
The small intestine is a rare source for upper gastrointestinal (GI) bleeding, as it accounts for only 5 % of cases. However, it is the most common cause of obscure GI bleeding and should thus be considered for all patients with GI bleeding and no source by standard endoscopic examination. Diagnosis has been historically difficult due to limited means of gaining access; however newer techniques have improved our diagnostic and therapeutic abilities. Small bowel tumors represent the second most common cause of small bowel bleeding after vascular malformations. The aim of this chapter is to examine the diagnostic and management approaches to the patient with bleeding small bowel tumors.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Raju GS, Gerson L, Das A, Lewis B, American Gastroenterological Association. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133(5):1697–717.
Katz LB. The role of surgery in occult gastrointestinal bleeding. Semin Gastrointest Dis. 1999;10(2):78–81.
Prakash C, Zuckerman GR. Acute small bowel bleeding: a distinct entity with significantly different economic implications compared with GI bleeding from other locations. Gastrointest Endosc. 2003;58(3):330–5.
Lewis BS. Small intestinal bleeding. Gastroenterol Clin North Am. 2000;29(1):67–95.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. Cancer J Clin. 2009;59(4):225–49.
Severson RK, Schenk M, Gurney JG, Weiss LK, Demers RY. Increasing incidence of adenocarcinoma and carcinoid tumors of the small intestine in adults. Cancer Edidemiol Biomarkers Prev. 1996;5(2):81–4.
Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, et al. Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry. Arch Surg. 2007;142(3):229–35.
Billimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63–71.
Haselkorn T, Qhittemore AS, Lilienfeld DE. Incidence of small bowel cancer in the United States and worldwide: geographic, temporal, and racial differences. Cancer Causes Control. 2005;16(7):781–7.
Pan SY, Morrison H. Epidemiology of cancer of small intestine. World J Gastrointest Oncol. 2011;3(3):33–43.
Reynolds I, Healy P, Mcnamara DA. Malignant tumours of the small intestine. Surgeon. 2014;12(5):263–70.
Sanchez-Capilla AD, De La Torre-Rubio P, Redondo-Cerezo E. New insignts to occult gastrointestinal bleeding: from pathophysiology to therapeutics. World J Gastrointest Pathophysiol. 2014;5(3):271–83.
Keum B, Chun HJ. Capsule endoscopy and double balloon enteroscopy for obscure gastrointestinal bleeding: which is better? Gastroenterol Hepatol. 2011;26(5):794–5.
Ogoshi K, Hara Y, Ashizawa S. New technique for small intestinal fiberoscopy. Gastrointest Endosc. 1973;20(2):64–5.
Pasha SF, Hara AK, Leighton JA. Diagnostic evaluation and management of obscure gastrointestinal bleeding: a changing paradigm. Gastroenterol Hepatol. 2009;5(12):839–50.
Chak A, Koehler MK, Sundaram SN, Cooper GS, Canto MI, Sivak Jr MV. Diagnostic and therapeutic impact of push enteroscopy: analysis of factors associated with positive findings. Gastrointest Endosc. 1998;47(1):18–22.
Lin S, Branch MS, Shetzline M. The importance of indication in the diagnostic value of push enteroscopy. Endoscopy. 2003;35(4):315–21.
Chak A, Cooper GS, Canto MI, Pollack BJ, Sivak Jr MV. Enteroscopy for the initial evaluation of iron deficiency. Gastrointest Endosc. 1998;47(2):144–8.
Santhakumar C, Liu K. Evaluation and outcomes of patients with obscure gastrointestinal bleeding. World J of Gastrointest Pathophysiol. 2014;15(4):479–86.
Carey EJ, Fleischer DE. Investigation of the small bowel in gastrointestinal bleeding—enteroscopy and capsule endoscopy. Gastroenterol Clin North Am. 2005;34(4):719–34.
May A, Nachbar L, Schneider M, Ell C. Prospective comparison of push enteroscopy and push and pull enteroscopy in patients with suspected small-bowel bleeding. Am J Gastroenterol. 2006;101(9):2016–24.
Matsumoto T, Moriyama T, Esaki M, Nakamura S, Iida M. Performance of antegrade double-balloon enteroscopy: a comparison with push enteroscopy. Gastrointest Endosc. 2005;62(3):392–8.
Saygili F, Saygili SM, Oztas E. Examining the whole bowel, double balloon enteroscopy: inducations, diagnostic yield and complication. World J Gastrointest Endosc. 2014;7(3):247–52.
Fry LC, Bellutti M, Neumann H, Malfertheiner P, Monkemuller K. Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding. Alim Pharmacol Ther. 2009;29(3):342–9.
Chen WG, Shan GD, Zhang H, Li L, Yue M, Xiang Z, et al. Double-balloon enteroscopy in small bowel tumors: a Chinese single-center study. World J Gastroenterol. 2013;19(23):3665–71.
Akerman PA, Cantero D. Spiral enteroscopy and push enteroscopy. Gastrointest Endosc Clin N Am. 2009;19(3):357–69.
Gostout CJ. Sonde enteroscopy. Technique, depth of insertion, and yield of lesions. Gastrointest Endosc Clin N Am. 1996;6(4):777–92.
May A, Farber M, Aschmoneit I, Pohl J, Manner H, et al. Prospective multicenter trial comparing push-and-pull enteroscopy with single- and double-ballon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010;105(3):575–81.
Domagk D, Mensink P, Aktas H, Lenz P, Meister T, et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy. 2011;43(6):472–6.
Efthymiou M, Desmond PV, Brown G, La Nauze R, Kaffles A, Chua TJ, et al. SINGLE-01: a randomized, controlled trial comparing the efficacy and depth of insertion of single-and double-balloon enterosopy by using a novel method to determine insertion depth. Gastrointest Endosc. 2012;76(5):972–80.
Gralnek IM. Obscure-overt gastrointestinal bleeding. Gastroenterology. 2005;128(5):1424–30.
Schulz HJ, Schmidt H. Intraoperative enteroscopy. Gastrointest Endosc Clin N Am. 2009;19(3):371–9.
Douard R, Wind P, Berger A, Maniere T, Landi B, Cellier C, et al. Role of intraoperative enteroscopy in the management of obscure gastrointestinal bleeding at the time of video-capsule endoscopy. Am J Surg. 2009;198(1):6–11.
Zaman A, Sheppard B, Katom RM. Total peroral intraoperative enteroscopy for obscure GI bleeding using a dedicated push enteroscope: diagnostic yield and patient outcome. Gastrointest Endosc. 1999;50(4):506–10.
Desa LA, Ohri SK, Hutton KA, Lee H, Spencer J. Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel origin. Br J Surg. 1991;78(2):92–5.
Kameda N, Higuchi K, Shiba M, Machida H, Okazaki H, Yamagami H, et al. A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. J Gastroenterol. 2008;43(6):434–40.
Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. World J Gastroenterol. 2008;14(34):5245–53.
Sato Y, Sagawa T, Hirakawa M, Ohnuma H, Osuga T, Okagawa Y, et al. Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions. Endosc Int Open. 2014;2(2):E80–7.
Ponsaing LG, Hansen MB. Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol. 2007;13(24):3316–22.
Kemp CD, Russell RT, Sharp KW. Resection of benign duodenal neoplasms. Am Surg. 2007;73(11):1086–91.
Chong KC, Cheah WK, Lenzi JE, Goh PM. Benign duodenal tumors. Hepatogastroenterology. 2000;47(35):1298–300.
Perez A, Saltzman JR, Carr-Locke DL, Brooks DC, Osteen RT, Zinner MJ, et al. Benign nonampullary duodenal neoplasms. J Gastrointest Surg. 2003;7(4):536–41.
Franklin Jr ME, Portillo G, Trevino JM, Gonzalez JJ, Glass JL. Laparoscopic intraluminal surgery for gastrointestinal malignancies. World J Surg. 2008;32(8):1709–13.
Schottenfeld D, Beebe-Dimmer DL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol. 2009;19(1):58–69.
Yantiss RK, Odze RD, Farraye FA, Rosenberg AE. Solitary versus multiple carcinoid tumors of the ileum: a clinical and pathologic review of 68 cases. Am J Surg Pathol. 2003;27(6):811–7.
Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol. 2001;33(4):267–82.
Witteman BJ, Janssens AR, Griffioen G, Lamers CB. Villous tumours of the duodenum. An analysis of the literature with emphasis on malignant transformation. Neth J Med. 1993;42(1–2):5–11.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing AG
About this chapter
Cite this chapter
Altieri, M.S., Pryor, A.D. (2016). Diagnosis and Management of Bleeding Small Bowel Tumors. In: Pryor, A., Pappas, T., Branch, M. (eds) Gastrointestinal Bleeding. Springer, Cham. https://doi.org/10.1007/978-3-319-40646-6_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-40646-6_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-40644-2
Online ISBN: 978-3-319-40646-6
eBook Packages: MedicineMedicine (R0)