Purpose: Spiral enteroscopy has been shown to be both safe and effective in the short-term for evaluation of obscure gastrointestinal bleeding, but longterm data is lacking. Methods: This is a prospective cohort study. All patients who underwent Spiral enteroscopy for evaluation of obscure GI bleeding at our institution were included. Outcomes assessed were post-procedure evidence of recurrent overt bleeding, pre- and post-procedure blood transfusion requirements and serum hemoglobin values, and need for additional therapeutic procedures. Results: Between February 2008 and March 2010, 79 patients underwent deep small bowel spiral enteroscopy for evaluation of GI bleeding. Long-term follow-up data (mean follow-up 25.3 ± 7.5 months; range 12.9 - 38.8 months) was obtained in 62 patients (#39/66% overt bleeding, #5/8% occult). Within 6 months prior to the Spiral enteroscopy, the patients had a mean of 4.9 ± 6.3 units (range 0 - 30) of packed red cells transfused and had a mean of 4 ± 1.4 (range 2 - 10) endoscopic procedures done for evaluation of the cause of GI bleeding. Thirty-seven (60%) patients had no therapy during initial Spiral enteroscopy and 22 (35%) patients had cautery of arteriovascular malformations. During the follow-up period, 46 (74%) patients had no evidence of recurrent bleeding. A mean of 2.1 units per patient of blood was transfused during the follow-up period. Thirty-seven (60%) patients required no additional endoscopic procedures. Only three patients required gastrointestinal surgery for findings not detected by Spiral enteroscopy. Mean hemoglobin value prior to Spiral enteroscopy was 10.44 ± 1.75, and mean hemoglobin value at follow-up was 12.61 ± 1.88. There were no procedure related adverse events. Conclusion: In patients with obscure GI bleeding, deep small bowel Spiral enteroscopy is safe and effective in reducing the incidence of overt bleeding and in decreasing the requirement for blood transfusions over a long-term follow-up.