Health Questions and Answers

Question: In the patient who has undergone multiple evaluations for the localization of recurrent occult GI bleeding without identification of a source, what test needs to be performed?


In patients who have had multiple upper GI endoscopies, colonoscopies, barium studies, and RBC scans without identification of the source of blood loss, enteroscopy needs to be performed. Enteroscopy can be performed either with push enteroscopy or wireless capsule endoscopy. The source of bleeding is most likely from AVMs (or angiodysplasias), usually hiding in the small intestine. Of particular note is that before a patient undergoes enteroscopy the hemoglobin should be 10 or higher to aid in detecting these tiny vessels.

Reference:  Sleisenger MH, Fordtran JS (eds): Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management, 7th ed. Philadelphia, W.B. Saunders, 2003.

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