| Theme |
Indications and Standards of Practice for Emergency Endoscopy |
| Title |
Small Bowel Bleeding |
| Author |
Masanao Nakamura |
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine |
| Author |
Naoki Ohmiya |
Department of Medicine and Gastroenterology, Fujita Health University, School of Medicinel |
| Author |
Yoshiki Hirooka |
Department of Endoscopy, Nagoya University Hospital |
| Author |
Hidemi Goto |
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine |
| [ Summary ] |
Capsule endoscopy (CE) and balloon-assisted endoscopy (BAE) serve as primary tools for diagnosis and treatment. Small bowel endoscopy guidelines that have been established in December 2015 recommend that in patients with a high index of suspicion for small bowel bleeding, clinicians should review the patient's clinical background. Enhanced computed tomography (CT) should initially be performed to evaluate any small bowelabnormality or extravasation of contrast agent into the lumen. In patients showing positive CT findings, BAE is recommended for endoscopic diagnosis and treatment. If CT shows negative findings, CE is preferred. The indication to perform an emergency endoscopy of the small bowel is ongoing bleeding, which means patients in whom blood stool is observed at the time of diagnosis and those in whom bleeding is observed to have stopped spontaneously within 48 hours of the endoscopic examination. Vascular lesions constitute the most common etiology diagnosed by emergency endoscopy (accounting for > 50 % of all etiologies). Therefore, an endoscopist ought to begin the emergency endoscopic procedure mindful of the possible presence of vascular lesions. |