The small bowel as a source of gastrointestinal blood loss |
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Authors: | Sandeep Lahoti MD Norio Fukami MD |
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Institution: | (1) MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 78, 77030 Houston, TX, USA |
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Abstract: | The small bowel is a rare but important source of blood loss from the gastrointestinal (GI) tract. In approximately 5% of
all patients with GI bleeding, no cause for the bleeding is evident even after an extensive workup. This bleeding is often
termed "gastrointestinal bleeding of obscure origin" or "obscure gastrointestinal bleed" (OGIB). Recent advancements in enteroscopy
have contributed to a better understanding of the small bowel as a source of bleeding. On average, 27% of patients with OGIB
have been shown to have lesions in the small bowel, with common findings including arteriovenous malformations (AVMs) and
small bowel tumors. The trend in primary diagnostic workup for obscure GI bleeding or suspected small bowel lesions is shifting
toward enteroscopic examination. Availability of an accessory channel now offers the clinician management options such as
endoscopic injection therapy, electrocautery, and polypectomy. The "gold standard" for examination of the entire small bowel
is intraoperative enteroscopy. A newer technique involving laparascopic assistance may lower the morbidity associated with
this examination. Combined hormonal therapy may be an alternative treatment for patients with AVMs or an unknown cause of
bleeding after enteroscopic examination. |
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