ENTEROSCOPY IN PATIENTS WITH GASTROINTESTINAL-BLEEDING OF OBSCURE ORIGIN

Approximately 5% of all patients with gastrointestinal hemorrhage will not have a bleeding site found after standard evaluation with upper e ndoscopy and colonoscopy. The source of bleeding in these patients is often the small intestine. In the past 2 decades, our ability to exami ne the small bowel endoscopically has been enhanced by the use of intr aoperative enteroscopy and the development of push and sonde enterosco pes. In a stepwise evaluation of the patient with obscure gastrointest inal bleeding using enteroscopy, the identification of a bleeding sour ce has been reported in 70-100% of patients, usually leading to pallia tive, if not definitive, therapy. In this review we discuss the indica tions, methods and yields of each of these procedures, and propose a d iagnostic algorithm with which to approach these patients.