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World J Gastrointest Pathophysiol. Nov 15, 2014; 5(4): 479-486
Published online Nov 15, 2014. doi: 10.4291/wjgp.v5.i4.479
Evaluation and outcomes of patients with obscure gastrointestinal bleeding
Cositha Santhakumar, Ken Liu
Cositha Santhakumar, Ken Liu, Department of Gastroenterology and Hepatology, Level 1 West, Concord Repatriation General Hospital, Sydney NSW 2139, Australia
Author contributions: Santhakumar C performed the literature review and composed the initial manuscript; Liu K was involved in editing the manuscript.
Correspondence to: Dr. Cositha Santhakumar, Department of Gastroenterology and Hepatology, Level 1 West, Concord Repatriation General Hospital, Sydney NSW 2139, Australia. cossiesan@hotmail.com
Telephone: + 61-2-97675000 Fax: +61-2-97676767
Received: January 28, 2014
Revised: June 30, 2014
Accepted: July 15, 2014
Published online: November 15, 2014
Processing time: 294 Days and 15.2 Hours
Abstract

Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Long-term outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and long-term clinical outcomes.

Keywords: Obscure gastrointestinal bleeding; Capsule endoscopy; Double balloon enteroscopy; Outcomes; Anaemia

Core tip: This article examines the role of current diagnostic modalities for the investigation of obscure gastrointestinal bleeding (OGIB) and outcomes in patients undergoing these investigations. Capsule endoscopy and double balloon enteroscopy remain the cornerstone of diagnostic and therapeutic management. The diagnostic and therapeutic capabilities of certain modalities are influenced by the nature of bleeding in OGIB. Long-term outcome data in patients with OGIB is limited but is most promising for capsule endoscopy.