The patient with recidivent obscure gastrointestinal bleeding.

Obscure gastrointestinal (GI) bleeding is defined as visible or invisible GI blood loss, the source of which can not be identified by standard endoscopy (oesophagogastroduodenoscopy and colonoscopy). Nowadays, GI bleeding is divided into upper, mid- and lower bleeding. Mid-GI bleeding covers the section from the Treitz ligament to the ileocaecal valve. The new diagnostic methods of capsule endoscopy and double balloon enteroscopy have revolutionised the diagnostic approach in recent years. As a result, previous radiological and nuclear medicine techniques (small bowel X-ray, scintigraphy and angiography), but also endoscopic techniques, such as the push enteroscopy and intraoperative endoscopy, are becoming less important. After standard endoscopy and persistent blood loss it is advisable to first have these procedures repeated by an experienced examiner under optimal conditions. Nevertheless, no source of bleeding is identified by this method in 5% of cases. It is then recommended to use capsule endoscopy and, depending on the findings, double balloon enteroscopy with the option of intervention. In patients with unstable circulation an invasive procedure (intraoperative endoscopy) may be required.