A/Prof David van der Poorten
Dr Roslyn Vongsuvanh
  Prof Golo Ahlenstiel
Dr Way Siow

Appointments & Enquiries:  (02) 8711 0160

Obscure Gastrointestinal blood loss and iron deficiency anaemia

Obscure GastrointestinaI blood loss often manifests as melaena (black, tarry stools due to altered blood) or iron deficiency anaemia. When gastroscopy and colonoscopy has failed to find a source of bleeding, capsule endoscopy is the best way to visualise the hidden parts of the small intestine and exclude a serious cause.

 

Specialised Service Provided

    • Investigation of obscure gastrointestinal blood loss and iron deficiency anaemia
    • Diagnosis and management of small bowel angioectasia
    • Diagnosis and management of small bowel tumours
    • Diagnosis and management of small bowel Crohn's disease

 

Diagnosis and Management of Angioectasia

One of the most common causes of obscure GI blood loss is small bowel angioectasia’s, also known as AVM’s or angiodysplasia’s. These small blood vessel malformations bleed very slowly and only cause symptoms due to the resulting anaemia. With careful inspection and the latest HD PillCam SB3 these lesions can reliably be diagnosed by capsule endoscopy. Once their location is pinpointed by the capsule it is often possible to eradicate them using specialized diathermy methods such as Argon Plasma Coagulation (APC) during enteroscopy.

 

Quick Case Study

A man in his 70’s saw me in late 2013 with iron deficiency anaemia and intermittent melaena over 5 months. He was on the blood thinner warfarin to treat vascular disease and had a number of stents. Gastroscopy and Colonoscopy were unremarkable. A capsule endoscopy the following week showed a number of angioectasia’s in his proximal jejunum and he proceeded to have an enteroscopy. All the angioectasia’s were located at push enteroscopy and successfully ablated using Argon Plasma Coagulation.

 

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Pill cam images of small bowel angioectasia.

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Angioectasia located and destroyed at enteroscopy.

 

 

Diagnosis and Management of Small Bowel tumours

Small bowel tumours are very rare, but whenever there is obscure GI blood loss they need to be excluded. Complete capsule endoscopy can reliably diagnose both primary and secondary small bowel tumours and when necessary enteroscopy can be performed to take tissue samples.

 

Quick Case Study

A man in 60’s came to see me in 2010 with severe iron deficiency anaemia that had been diagnosed overseas. A gastroscopy and colonoscopy had already been performed in his home country and had not identified a source of bleeding. He underwent capsule endoscopy and was found to have a tumour in the early part of his small intestine (proximal jejunum). The lesion was biopsied by push enteroscopy and confirmed to be a primary small bowel adenocarcinoma. Subsequent PET scan showed no signs of spread so I referred him to a GI surgeon for resection. He had the tumour removed laparoscopically (keyhole surgery) and subsequently underwent 6 months of chemotherapy. 4 years on he remains in a complete remission with no signs of any tumour recurrence.

 

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Small bowel tumour seen at pill cam.

 

 

Diagnosis and Management of Crohn’s disease

Occasionally Crohn’s disease only affects the small intestine and cannot be diagnosed on standard gastroscopy and colonoscopy. With the HD imaging of PillCam SB3 even tiny ulcers, erosions and redness of the intestinal lining can be detected. Biopsy can subsequently be performed using push or balloon enteroscopy depending on the location of the diseased areas. Medicare rebates Capsule endoscopy only when there are signs of blood loss or iron deficiency associated with Crohn’s disease. In other cases, or when used as a monitoring tool, the procedure can be paid for privately.