Chetcuti Zammit Stefania, Sidhu Reena
Gastroenterology Department, Sheffield Teaching Hospitals, Sheffield, UK.
Curr Opin Gastroenterol. 2018 May;34(3):165-174. doi: 10.1097/MOG.0000000000000429.
The objective is to provide an overview on the cause of small bowel bleeding. We discuss the role of small bowel endoscopy in the management of small bowel bleeding and provide an outline of pharmacotherapy that can be additionally beneficial.
Small bowel capsule endoscopy (SBCE) is the initial diagnostic investigation of choice in small bowel bleeding. Computed tomography (CT) can be helpful in the context of small bowel tumours. Device-assisted enteroscopy (DAE) enables several therapeutic procedures such as argon plasma coagulation (APC) and haemoclip application. It can also guide further management with histology or by marking culprit lesions with India ink. A persistent rate of rebleeding despite APC is increasingly being reported. Pharmacotherapy has an emerging role in the management of small bowel bleeding. Somatostatin analogues are a well tolerated class of drugs that can play an additional role in the management of refractory bleeding secondary to small bowel angioectasias.
SBCE is useful in determining the cause of small bowel bleeding. DAE offers an endoscopic therapeutic approach to small bowel bleeding replacing surgery and intraoperative enteroscopy. Pharmacotherapy, in addition to endotherapy, can play an important role in the management of multifocal, recurring bleeding small bowel lesions.
旨在概述小肠出血的病因。我们讨论小肠内镜检查在小肠出血管理中的作用，并概述可能具有额外益处的药物治疗方法。
小肠胶囊内镜检查（SBCE）是小肠出血首选的初始诊断检查。计算机断层扫描（CT）在小肠肿瘤的情况下可能会有所帮助。器械辅助小肠镜检查（DAE）能够进行多种治疗操作，如氩等离子体凝固（APC）和钛夹应用。它还可以通过组织学检查或用印度墨水标记可疑病变来指导进一步的治疗。尽管越来越多地报道了尽管进行了APC治疗仍持续出血的情况。药物治疗在小肠出血的管理中正在发挥越来越重要的作用。生长抑素类似物是一类耐受性良好的药物，在治疗小肠血管扩张引起的难治性出血方面可以发挥额外作用。
SBCE有助于确定小肠出血的原因。DAE为小肠出血提供了一种内镜治疗方法，取代了手术和术中小肠镜检查。除了内镜治疗外，药物治疗在多灶性、复发性小肠出血病变的管理中可以发挥重要作用。
