| [ Summary ] |
The advent of capsule endosopy (CE) and double balloon endosocpy (DBE) have changed the diagnostic algorithm for diagnosis and treatment of bleeding in the small intestine. In particular, DBE has provided not only endoscopic diagnosis, but also treatment. Although more than 100 facilities in Japan were using DBE at the end of 2006, only a few facilities use CE because of delays in authorization of CE. Therefore, in practical algorithm for small intestine bleeding in our facility, primarily employing DBE, are described. Case histories and results of other modalities are important in selecting insertion routes, type of endoscope, and type of hood. During this procedure, marking clips and submerged observation are useful in determining the origins of bleeding. Realtime endoscopic observations with, consideration of the presence or absence of pulsations, provide important information concerning selecting endoscopic treatments. In cases where there is a failure to identify the origins of recurrent bleeding in the small intestine, despite repeated DBE, CE should be considered. |