Obscure GIB

(Am J Gastro 2015;110:1265; Gastro 2017;152:497)

Definition

continued bleeding (melena, hematochezia) despite ⊖ EGD & colo; 5% of GIB

Etiologies

Dieulafoy’s lesion, GAVE, small bowel angiodysplasia, ulcer or cancer, Crohn’s disease, aortoenteric fistula, Meckel’s diverticulum, hemobilia

Diagnosis:

• repeat EGD w/ push enteroscopy/colonoscopy when bleeding is active
• If ⊖, video capsule to evaluate small intestine (contraindic. if stricture) (GIE 2015;81:889)
• If still ⊖, consider 99mTc-pertechnetate scan (“Meckel’s scan”), enteroscopy (single-balloon, double-balloon, or spiral), tagged RBC scan and arteriography