GASTROENTEROLOGY ARTICLE OF THE WEEK
October 29, 2009
Gerson LB. Recurrent gastrointestinal bleeding after negative upper endoscopy and colonoscopy. Clin Gastroenterol Hepatol 2009;7:828-833.
1. Meckel’s diverticulum
a. Is typically located in the mid-jejunum
b. When present, and if larger than 2 cm, will be detected by a Meckel scan
c. Diagnostic accuracy of the Meckel scan is between 50% to 90%
d. Gastric mucosa is present in 10% to 60% of Meckel diverticuli.
e. Bleeding from a Meckel is more common in adults than children
True or False
2. Small bowel tumors typically continue to bleed if undetected, AVM’s often stop bleeding, sometimes for long periods of time
3. If a patient has recurrent melena after undergoing normal EGD and colonoscopy, the next step is capsule endoscopy
4. Deep enteroscopy has been associated with 1% complication rate
5. Small bowel tumors are more common in older patients presenting with obscure GI bleeding
6. Patients with a negative capsule endoscopy study have a 5% chance of rebleeding during the following year
7. Missed rates of capsule endoscopy are estimated at 20% to 30%, a repeat CE exam is not unreasonable when re-bleeding occurs despite a normal initial exam
8. Visualization of AVM’s in capsule endoscopy should be followed by deep enteroscopy to treat the AVM’s in the majority of patients
9. There is no evidence that treating AVM’s endoscopically affect the bleeding rate of these lesions