GI Bleeding
Upper endoscopy is the procedure of choice for diagnosing upper GI bleeding preferably within the first 24 hours. It can reach to the 2nd portion of the duodenum in the majority of cases and to lesser extent to the 3rd and 4th parts of the duodenum.
Upper GI barium studies are contraindicated with acute upper GI bleeding due to interference with endoscopy, angiography, or surgery if needed.
Colonoscopy is the procedure of choice for the diagnosing lower GI bleeding.
If both upper and lower endoscopies are negative in an otherwise stable slow bleeding or hemoccult patient then wireless capsule endoscopy is the next step.
If bright red blood per rectum with estimated rate of bleeding 0.3-0.5 mL/min then CT angiography is next. If rate of bleeding is suspected to be 0.5 -1 mL/min then angiography is recommended as these are unstable and need immediate embolization. Technetium-99m (99mTc)-labeled red blood cell scintigraphy/Radionuclide imaging can detect bleeding at a rate of 0.1-0.5 mL/min but its disadvantage is that the bleeding site is poorly localized.
Push enteroscopy can reach approximately the proximal 60 cm of the jejunum.
Deep small bowel enteroscopy, also called a balloon assisted enteroscopy, scope is advanced through the small bowel while the balloons are inflated and deflated to create push-and-pull method that advances the endoscope through the entire bowel (similar to pulling a curtain over a rod). The endoscope can be inserted through the mouth (antegrade) or through the rectum (retrograde) depending on the area of interest.
Gastroenterology Clinical focus book for further reading.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.