Abstract
An etiology for chronic GI blood loss can be diagnosed by EGD and colonoscopy in approximately 95% of patients. 1 Myers RT. Diagnosis and management of occult gastrointestinal bleeding: visualization of the small bowel by fiberoptic colonoscopy. Am Surg. 1976; 42: 92-95 PubMed Google Scholar , 2 Netterville R Hardy J Martin R. Small bowel hemorrhage. Ann Surg. 1968; 167: 949-957 Crossref PubMed Scopus (36) Google Scholar If only patients without overt bleeding but with iron deficiency anemia are evaluated, the diagnostic yield falls to approximately 66% after EGD and colonoscopy. 3 Zuckerman G Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol. 1992; 87: 62-66 PubMed Google Scholar , 4 Rockey DC Cello JP. Evaluation of the gastrointestinal tract in patients with iron deficiency anemia. N Engl J Med. 1993; 329: 1691-1695 Crossref PubMed Scopus (468) Google Scholar The subsequent evaluation may include push enteroscopy, barium small bowel examinations, nuclear medicine studies, and angiography. If these studies are nondiagnostic and symptoms and/or anemia persist, a more aggressive approach is warranted. 5 Waye JD. Enteroscopy. Gastro Endo. 1997; 46: 247-256 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Sonde enteroscopy allows evaluation of all or nearly all of the small intestine. 6 Gostout CJ. Sonde enteroscopy. Gastrointest Endosc Clin of N Am. 1996; 6: 777-792 Abstract Full Text PDF PubMed Google Scholar This procedure is limited by the endoscope with incomplete control over rate of withdrawal, poor tip control, and no therapeutic capabilities. Despite this, approximately 50% to 70% of the small intestine lumen is estimated to be visualized with a diagnosis being made in about 25% to 75% of cases. 5 Waye JD. Enteroscopy. Gastro Endo. 1997; 46: 247-256 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar If all the above have failed to identify a lesion, a complete small bowel examination with intraoperative enteroscopy is usually the next step.
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