Curriculum · Gastroenterology
Obscure gastrointestinal bleeding
What it is
Obscure GI bleed is the bleed that the two usual scopes do not reach. An upper GI bleed from the stomach is ruled by EGD and a lower GI bleed from the colon is ruled by colonoscopy, so what is left is the middle, the small intestine, and that is where capsule endoscopy is used.
How it is diagnosed
Capsule endoscopy comes first, and its results help double balloon endoscopy, also called enteroscopy, localize the source of bleeding. Angiography is used if the overt bleeding is hemodynamically significant, estimated at more than 0.5 cc/min. CT enterography is used if wireless endoscopy capsule or double balloon endoscopy is not available.