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home - Miscellaneous - Bleeding - Obscure GI Bleeding Written by Dr Sebastian Zeki

Obscure GI Bleeding

Definition: No cause found for FOB+ve or iron deficiency anaemia after OGD/ Colonoscopy and radiological studies Evaluation of occult GI bleeding Evaluation of Obscure GI Bleeding Obscure- Overt GI Bleeding Obscure- Occult GI Bleeding Definition: Persistent GI bleeding with normal OGD/ colonoscopy and radiological studies AetiologyPatients < 40:Inflammatory bowel diseaseMeckel's diverticulumDieulafoy's lesionSmall bowel tumor (eg, lymphoma, carcinoid, adenocarci-noma, or polyp).Patients >40Vascular lesionsErosions or ulcers related to nonsteroidal anti-inflammatory drugs. Repeat upper endoscopy and colonoscopy Lesions commonly missed on upper GI endos-copy.Cameron's ulcers.Peptic ulcers.Vascular ectasias.D2 biopsies should be taken.Angioectasia is missed on the medial aspect of the second part of the duodenum (consider using a side-viewer- also useful for haematobilia). Wireless video capsule endoscopy Capsule can reveal 40% more pathologies than push enteroscopy alone. Push enteroscopy Scope is 230 cm but can only examine 150 cm of small bowel.It identifies pathology in 40%.Angiodysplasia are the most common lesions.Often lesions are found within the reach of a normal OGD. Intraoperative enteroscopy Surgeon telescopes bowel over scope per oral and per rectal.The diagnostic yield is 75%. Double-balloon enteroscopy By sequential inflation of two balloons and passage of an overtube, it pleats the small bowel over the enteroscope.Probably better if done after capsule. Small bowel series and enteroclysis Enteroclysis better than SBFT .Yield for obscure bleeding still< 20 %.It is usually used when capsule endoscopy and enteroscopy are unavailable or contraindicated. Radionuclide scanningThis detects bleeding that is occurring at a rate of 0.1-0.5 mL/minute and only localizes bleeding to an area of the abdomen, with accuracy of 85%.It is more sensitive than angiography, but less specific than angiography. Angiography This is only useful if the patient is transfusion dependent. Consider Meckel’s scan in the right population Two types of scans:a)Technetium (99mTc) sulfur colloid. b)99mTc pertechnate-labeled autologous red blood cells. 1. Written by Dr Sebastian Zeki

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