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The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI
bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia
is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tum...
Context in source publication
Context 1
... summary, most parameters are comparable among all the three deep enteroscopy techniques; how- ever, the procedural time is shorter in SE, as compared with SBE and DBE. The complete enteroscopy rate is higher in DBE than that of SBE and SE; but the clinical impact of complete enteroscopy needs further evaluation (Table 2). ...
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Background
The aim of the study was to compare results off‐pump coronary artery bypass (OPCAB) combined mitral valve reconstruction (MVR) with standard on‐pump approach.
Methods
From January 2014 to December 2017, a total of 53 patients received a combined myocardial revascularization and MVR for multivessel coronary artery disease (CAD) complicat...
Citations
... Several treatments have been attempted for gastrointestinal bleeding due to BRBNS, including systemic therapy, endoscopy, and surgery [6]. Push enteroscopy alone in the treatment of small bowel bleeding is difficult, carries a moderate complication risk, and may be non-diagnostic [7]. Intraoperative enteroscopy is deemed the gold standard for localization and treatment of small bowel gastrointestinal bleeding [8]. ...
... Gastrointestinal bleeding from the small bowel is overall rare. Arteriovenous malformations are the most common cause of bleeding from the small bowel, such as angiodysplasia, telangiectasia, small bowel varices, and Dieulafoy lesions [7]. The treatment options are typically limited to radiological intervention, surgical resection, or push enteroscopy [6]. ...
... Any bleeding point that is proximal to this would be considered as an Upper GI bleed [1,2]. There are several causes leading to an LGIB, most notably diverticular disease, inflammatory (Crohn's disease or Inflammatory bowel disease), vascular conditions (angiodysplasia), colitis, tumours and iatrogenic (non-steroidal anti-inflammatory drugs, surgery, endoscopy) [2][3][4]. Risk factors include ageing and the use of anticoagulation medication such as apixaban [2,4,5]. 1 2 1 1 In the United Kingdom, there are currently no National Institute for Health and Care Excellence (NICE) guidelines surrounding the safe discharge of patients with LGIB. However, in 2019, guidelines were published in the British Society of Gastroenterology by Oakland et al. ...
... There are several causes leading to an LGIB, most notably diverticular disease, inflammatory (Crohn's disease or Inflammatory bowel disease), vascular conditions (angiodysplasia), colitis, tumours and iatrogenic (non-steroidal anti-inflammatory drugs, surgery, endoscopy) [2][3][4]. Risk factors include ageing and the use of anticoagulation medication such as apixaban [2,4,5]. 1 2 1 1 In the United Kingdom, there are currently no National Institute for Health and Care Excellence (NICE) guidelines surrounding the safe discharge of patients with LGIB. However, in 2019, guidelines were published in the British Society of Gastroenterology by Oakland et al. ...
Introduction
Lower gastrointestinal bleeds (LGIB) are defined by having a bleeding point in the gastrointestinal tract beyond the ligament of Treitz. The most common causes include diverticular bleeds, tumours, and colitis. There are no National Institute for Health and Care Excellence (NICE) guidelines regarding safe discharge of patients with LGIB. The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology (BSG) guidelines, in patients presenting with LGIB at William Harvey Hospital.
Methods
Patients with LGIB who presented to Accident & Emergency or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patients’ Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients’ admission, discharges, and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. Patients with no adverse outcomes were deemed to have had a safe discharge. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome (and therefore safe discharge) were calculated.
Results
A total of 123 patients were included. These led to a total of 144 LGIB presentations to the hospital. Twenty-nine patients had an Oakland score of ≤8; 21 (72.4%) cases were initially discharged with four representations (19.0%) and eight (27.6%) were admitted although none of these suffered from any adverse outcomes. For those who scored ≤8, 25 (86.2%) were therefore deemed to have had a safe discharge. A total of 115 had a score >8; 43 (37.4%) were initially discharged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome including 16 (13.9%) representations, 21 (18.3%) blood transfusions, three (2.6%) surgical interventions and one (0.9%) endoscopic haemostasis. Out of the 115 cases which scored >8, 74 (64.3%) were deemed to have had a safe discharge. The AUROC for safe discharge was 0.84.
Conclusion
The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score of >8 could be used as many patients with a higher score did not experience adverse outcomes.
... Small intestinal bleeding remains a challenging and perplexing issue in clinical practice. [1][2][3] Various international societies have tried to address this entity to varying extent. American College of Gastroenterology (ACG) replaced the term obscure gastrointestinal (GI) bleeding with small intestinal bleeding because of the refinement and improvement in the technology of direct endoscopic visualization of small bowel mucosa by capsule video endoscopy. ...
... 5 Of the various causes of obscure GI bleeding, small bowel angiodysplasias (SBA) remains an important cause contributing to 5 to 10% of these episodes. 2,[6][7][8] Small bowel bleeding can manifest as overt bleeding, either as melena or hematochezia or it can be in form of occult bleeding manifesting as iron deficiency or it can be detected in stool sample as occult blood positivity. 6 Angiodysplasias are ectatic vessels that form in the mucosa and submucosa and these aberrant vessels are prone to bleeding. ...
... These agents tend to cause splanchnic vasoconstriction and limit the production of vascular endothelial growth factor (VEGF). 2 In a retrospective study, long-acting analogue of octreotide was used in 98 patients with angiodysplasia and authors reported significantly better control of bleeding with 40.8% having complete control of bleeding, 32.6% having a relapse of bleeding episode, and 26.5% patients not responding. 14 A nonrandomized comparative study comparing 32 refractory SBA bleeding patients treated with octreotide to an external placebo control group of 38 patients reported a significant decrease in rebleeding rate and need for oral iron. ...
Because of both difficulties in accurate diagnosis and appropriate management, small bowel bleeding due to angiodysplasia remains a challenging and perplexing issue in clinical practice. Advancement in small bowel endoscopy including capsule endoscopy as well as balloon enteroscopy has expanded the domain of endoscopic hemostatic interventions in the small bowel. This has led on to marked improvement in immediate homeostasis rates in patients with small bowel angiodysplasias (SBA) bleeding. However, high recurrent bleeding rates are an important limitation of endoscopic interventions. Therefore, there is an unmet need of an effective therapeutic as well as prophylactic pharmacotherapy that can alter the course of the disease. Long-acting octreotide as well as thalidomide has been used in patients with SBA bleeding with encouraging results, but the evidence on their efficacy is not robust. In news and views of this issue, we discuss a randomized controlled study that investigates the efficacy and safety of thalidomide for the treatment of recurrent bleeding due to SBA.
... Newer techniques, such as capsule endoscopy, double-balloon enteroscopy, single-balloon enteroscopy, spiral enteroscopy, and computed enterography, play a key role in the diagnosis of small bowel hemorrhage. 4 A standard treatment for small bowel varices has not been established owing to its rarity. Managing small bowel variceal bleeding can vary depending on the indications, expertise, Table 2 lists the baseline characteristics and clinical outcomes of three patients with TAE. ...
Small bowel variceal bleeding is a rare cause of gastrointestinal hemorrhage, with clinical manifestations ranging from asymptomatic incidental findings to life-threatening conditions. The diagnosis and management of small bowel bleeding are challenging because of the localization of the lesion and the difficulty of the procedure. Trans-arterial embolization (TAE) is a secure and straightforward method for treating ectopic varices. On the other hand, there have been limited local studies on the outcomes of TAE for patients with small bowel variceal hemorrhage. This paper reports patients diagnosed with small bowel variceal bleeding and treated with TAE.
... One of the most common indications for enteroscopy, however, is represented by positive capsule endoscopy results for bleeding and a need for hemostasis because of erosions and ulcers [52]. The etiology is vast, including systemic diseases such as Chron's disease, neoplasms, infections, and celiac disease, as well as secondary to NSAID administration [53]. ...
Background: Small bowel disorders present a diagnostic challenge due to the limited accessibility of the small intestine. Accurate diagnosis is made with the aid of specific procedures, like capsule endoscopy or double-ballon enteroscopy, but they are not usually solicited and not widely accessible. This study aims to assess and compare the diagnostic effectiveness of enteroscopy and video capsule endoscopy (VCE) when combined with artificial intelligence (AI) algorithms for the automatic detection of small bowel diseases. Materials and methods: We performed an extensive literature search for relevant studies about AI applications capable of identifying small bowel disorders using enteroscopy and VCE, published between 2012 and 2023, employing PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and ClinicalTrials.gov databases. Results: Our investigation discovered a total of 27 publications, out of which 21 studies assessed the application of VCE, while the remaining 6 articles analyzed the enteroscopy procedure. The included studies portrayed that both investigations, enhanced by AI, exhibited a high level of diagnostic accuracy. Enteroscopy demonstrated superior diagnostic capability, providing precise identification of small bowel pathologies with the added advantage of enabling immediate therapeutic intervention. The choice between these modalities should be guided by clinical context, patient preference, and resource availability. Studies with larger sample sizes and prospective designs are warranted to validate these results and optimize the integration of AI in small bowel diagnostics. Conclusions: The current analysis demonstrates that both enteroscopy and VCE with AI augmentation exhibit comparable diagnostic performance for the automatic detection of small bowel disorders.
... La hemorragia de tubo digestivo (HTD) se manifiesta como hematemesis, melena, hematoquecia, rectorragia, sangre oculta en heces o anemia. Según su localización anatómica, puede clasificarse en: 1) hemorragia de tubo digestivo alto (HTDA), con pérdida sanguínea proximal al ámpula de Vater 1 ; 2) hemorragia de tubo digestivo bajo (HTDB), que ocurre de la válvula ileocecal al ano 2 , y 3) hemorragia de tubo digestivo medio, que se localiza entre el ámpula de Vater y la válvula ileocecal 3 . En México existen pocos reportes estadísticos acerca de las causas de la HTD. ...
Introducción:
La hemorragia digestiva es la pérdida de sangre que se origina en el tubo digestivo.
Objetivo:
Describir los hallazgos endoscópicos en pacientes evaluados por hemorragia de tubo digestivo alto (HTDA) y bajo (HTDB) en un hospital de segundo nivel del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) en Oaxaca, México.
Método:
Durante 3.5 años se realizaron 4285 esofagogastroduodenoscopias y colonoscopias.
Resultados:
De 778 solicitudes, el 74.5% fueron por HTDA y el 25.5% por HTDB. Las causas más frecuentes de HTDA no variceal fueron úlcera péptica (19%) y gastropatía erosiva (15%), y las de HTDA variceal fueron varices esofágicas (23%) y gastropatía hipertensiva (13%). Las causas más frecuentes de HTDB fueron hemorroides (53.5%) y divertículos (18.5%).
Conclusiones:
Los hallazgos endoscópicos más frecuentes en los pacientes evaluados endoscópicamente por HTDA fueron úlcera péptica, gastropatía erosiva y varices esofágicas, mientras que para los pacientes evaluados por HTDB fueron hemorroides y divertículos del colon.
... Small bowel is the most common cause of obscure GI bleed. This can be a perplexing problem in elderly who are more likely to have vascular anomalies, ulceration, NSAID-induced enteropathy, small intestinal tumors, and nonspecific enteritis [26]. Usually, small bowel ulcerations are commonly associated with chronic NSAID use (60-70 % of patients with chronic NSAID use). ...
... Vascular lesions are an important cause of obscure GI bleed. Angio ectasia (AE), Dieulofoy's lesion (DL) and Arteriovenous malformation (AVM) contribute to around 5% of all causes of GI bleed [26]. Increasing age, apart from chronic kidney disease (CKD), aortic stenosis (Heyde's syndrome), venous thromboembolism (VTE), and the use of warfarin are associated with increasing frequency of angiodysplasia [28]. ...
The spectrum of gastrointestinal (GI) issues in the older population varies from common physiological age-related changes to devastating, less common sinister pathological illness. GI system has direct exposure to external environment. Thus, it is modeled to embrace the pathophysiological changes that occur due to interaction with external factors. Gastrointestinal tract (GIT) per se is more resilient to aging as compared to other organ systems. On the other hand, elderly may present with a large plethora of GI symptoms. This presents a challenge to all echelons of medical consultation for accurate attribution for the aging process or pathophysiological causation of GI symptoms. This dichotomy leads to hindrance in adequate and appropriate treatment of GI ailments. In GI system, non-neoplastic disorders are far more common than neoplastic disorders. Hence, it becomes imperative to understand the aging evolution of the GI system and management of GI disorders in the older population.
... Традиционно все желудочно-кишечные кровотечения подразделяют на геморрагию из верхних отделов желудочно-кишечного тракта (ЖКТ) и нижних его отделов. В зарубежной литературе первый вид геморрагии получил название UGIB (upper gastrointestinal bleeding), источником которого являются заболевания слизистой оболочки пищеварительной трубки проксимальнее связки Трейца, а второй -LGIB (lower gastrointestinal bleeding) -с источником геморрагии дистальнее вышеназванного ориентира (включая тонкую и толстую кишку) [1]. ...
... For lesions that cannot be touched by routine gastroenteroscopy, CE provides the surgical approach for the next operation, and the combination of intraoperative endoscopy for localization is the key to the success of the operation. After the introduction of CE, the surgical success rate and mortality rate were improved compared with those before the introduction of CE, but the postoperative complications were still as high as 31%.However, patients should still be operated actively if they have life-threatening bleeding, failure of other hemostatic techniques, hemodynamic instability , deterioration of the condition, recurrent bleeding and intestinal segments that cannot be reached by endoscopy [20,21,22]. In this case, the patient was discharged on the 11th day after surgery. ...
Angioectasias lesions are multiple and involve a wide range, gast rointestinal bleeding can occur repeatedly or stop spontaneously, mostly in the colon. We report the real-life case of gastrointestinal bleeding in the small intestine. Small intestinal angioectasias (SBAEs) is a common cause of obscure gastrointestinal bleeding (OGIB). Due to the limited means for small intestine examination, the source cannot be found and missed diagnosis, resulting in delayed treatment. The application of capsule endoscopy not only greatly improves the diagnosis yield but also helps clinicians to formulate the next treatment plan. It is recommended to perform capsule endoscopy for those patients with gastrointestinal bleeding who cannot be identified after conventional gastroenteroscopy.
... gastrointestinal stromal tumors, leiomyoma and mass lesions, etc.) and vascular lesions (e.g. angioectasia, telangiectasia and angioma, etc.), 11 inflammatory lesions (e.g. erosion, ulceration, erythema, gastritis, duodenitis, jejunitis, ileitis, Crohn's disease, etc.), other lesions (e.g. ...
... Telangiectasia is lack of capillaries, directly connecting arteries to veins, and has excessive layers of smooth muscle without elastic fibers. 11 Besides, ischemia or infiltration of neoplastic lesions could result in small intestine bleeding. 11 Angioectasia belonging to P2 lesions with high risk of bleeding is a major cause of small bowel bleeding, and its main location is proximal small intestine. ...
... 11 Besides, ischemia or infiltration of neoplastic lesions could result in small intestine bleeding. 11 Angioectasia belonging to P2 lesions with high risk of bleeding is a major cause of small bowel bleeding, and its main location is proximal small intestine. 25 In the present study, we also noticed that 18 patients with active bleeding, meaning that those might require more aggressive healthcare. ...
Background and aim:
Capsule endoscopy (CE) has been used in clinical examination among people of various ages, while few studies exclusively focused on the young. We aimed to explore its clinical features in young adults and those with obscure gastrointestinal bleeding (OGIB).
Methods:
A total of 479 young adults aged 18-44 years were analyzed, with median age of 33 years. Primary positive findings of patients were classified into four kinds of lesions, and potential risk of bleeding among patients with OGIB was assessed based on Saurin classification (P0-2 lesions).
Results:
The overall completion rate and diagnostic yield of CE among young adults were 89.77 and 77.04%, respectively. Significant differences were found among overall completion rate/diagnostic yield and inpatient status/CE brand. Positive diagnostic yield among 157 patients with OGIB was 51.59% (P1-2 lesions), and the significant risk of bleeding was 37.04% (P2 lesions). Among patients with OGIB in which 134 patients with a total of 216 lesions, ulceration was the commonest P2 lesions, followed by angioectasia and telangiectasia. Inpatient rate, completion rate, and diagnostic yield were higher among patients with overt OGIB, and disease categories of overt OGIB were different compared with occult OGIB.
Conclusion:
CE is an optimal tool for discovering lesions in young adults and could play a role in evaluating the bleeding risk of young adults with OGIB.
