Diagnosis and therapeutic strategies for small bowel vascular lesions

Figure 4 Diagnostic algorithm for small bowel vascular lesions. Note: ¹Computed tomography (CT) scan is especially recommended for patients with ongoing overt obscure gastrointestinal bleeding (OGIB). CT enterography can be replaced to multiphase CT or radionuclide scanning, considering patients general condition; ²Repeated video capsule endoscopy is recommended if the disease presentation changes from occult to overt or if a rapid decrease in the serum hemoglobin level is confirmed. Urgent deep enteroscopy may be useful to reveal the bleeding source in patients with recurrent overt OGIB; ³Surgical intervention with intra-operative endoscopy will be conducted when superselective transcatheter embolization was failed. Meanwhile subsequent endoscopic examination is recommended to reveal bleeding origin, even if hemodynamic instability was relieved. OGIB: Obscure gastrointestinal bleeding; CTE: Computed tomography enteroscopy; VCE: Video capsule endoscopy; DE: Deep enteroscopy; IOE: Intra-operative endoscopy; CT: Computed tomography.