Obscure GIT Bleeding Dr. Mohamed Alsenbesy

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Presentation transcript:

Obscure GIT Bleeding Dr. Mohamed Alsenbesy By Dr. Mohamed Alsenbesy Assistan Prof. of Internal Medicine

GIT Bleeding Definitions & Descriptions Upper & Lowe GI bleeding: ligament of Treitz. Haematemesis & Melena. Haematochesia: fresh blood per rectum. Occult GI Bl. positive fecal occult blood test (FOBT) and/or iron-deficiency anemia (IDA), with no evidence of visible blood loss to the patient or physician.

Obscure GI Bl +ve occult bl. , recurrent Haematochezia or unexplained Iron def. Anaemia with –ve upper & lower GI Endoscopy. Acounts for 5% of all GIT bleeding (suryakanth 2006) Obscure overt or occult.

Obscure GI Bleeding Small Intestinal Causes Angiodysplasia. Crohn's disease Small bowel tumors. Small bowel ulcers and erosions. NSAID Small bowel diverticulosis/varices. Lymphangioma. Radiation enteritis. Osler-Weber-Rendu syndrome. Von Willebrand's disease. Small bowel polyposis syndromes. Aortoenteric fistula. Amyloidosis. Meckel's diverticulum. Hemobilia.

Diagnosis Push enteroscopy . Conventional & CT Angiography. Small bowel follow-through/enteroclysis Intraoperative Enteroscopy. Tagged red blood cell scan. Capsule endoscopy. Double Balloon Endoscopy.

Video Capsule Endoscopy New method to evalute obscure bleeding. FDA approved in 2001. The system consists of:- 1. Capsule.(11x26mm) 2. Sensory Array. 3. Data Recorder.

Capsule Endoscopy Angiodysplasia Celiac Crohn‘s

Double Balloon Enteroscopy Developed by Yamamoto in 2001. known as „Push – Pull Enteroscopy“.

Double Balloon Enteroscopy Indications Obscure GIT bleeding. ERCP after gastric surgery with long afferent limbs

Double Balloon Enteroscopy Advantages Visualization of the entire small bowel. Biopsy & intervention. Disadvantages Time consuming.

Double Balloon Enteroscopy Normal Intestinal mucosa Intestinal Polyp

Double Balloon (DB) versus Capsule Endoscopy (CE) Average 72% diagnostic yields. DB detected 2/3 of CE +ve lesions. DB detected lesions in 1/3 of patients with –ve CE results. DB and CE were comparable in detecting ulcers and Angiodysplasias.

Double Balloon (DB) versus Capsule Endoscopy (CE) DB was more effective in detecting mucosal and submucosal polyps. Average time: CE=44 min. DB= 94min.

Summary 5% of GIT bleeding is obscure. DB and CE are new promising diagnostic tools. CE is less invasive but no intervention. DB allows intervention but time consuming. Initial workup should be the repeat of Upper&lower Endoscopy.

Thank You