Obscure gastrointestinal bleeding.

I want to convey the notion that enteroscopy has opened many doors, and continues to open up more doors, in understanding and diagnosing diseases of the small intestine. The true nature of small-bowel angiodysplasia is still unanswered. It seems unlikely that the lesions in the small bowel are similar to the lesions that Scott Boley talks about in the right colon. I doubt that the intermittent obstruction to venous outflow, theorized in the colon, is the pathophysiologic change in the small intestine. Those studies, trying to look for the changes that Boley described, need to be done. We are trying to better characterize angiodysplasia of the small intestine, understanding where they occur, with how many lesions, and whether they are associated with any other illnesses. We are looking at the association of small-bowel vascular lesions with lesions in the stomach and colon. Enteroscopy will in the future, we hope, answer these questions. Enteroscopy, especially push enteroscopy, can help us with the treatment of angiodysplasias. We are now evaluating new instruments that reach not just two feet beyond the ligament of Treitz, but the entire jejunum, reaching 6 feet beyond the ligament of Treitz (16). Enteroscopy facilitates clinical research, can be used in patient care, and guides treatment.