Identification of occult bleeding source
Diagnosis of occult bleeding from the gastrointestinal tract can be difficult. Two approaches for the diagnosis of obscure bleeding in the small bowel are capsule endoscopy and single-balloon enteroscopy (SBE).
Capsule endoscopy is appropriate for diagnosis of occult bleeding in the duodenum as well as the diagnosis of Crohn’s disease and small bowel tumours. SBE allows the visualisation of the entire small intestine in real time, with the added advantage of being able to conduct endoscopic treatment of detected lesions. It is also a more simple and quick technique than double-balloon enteroscopy.
Before patients with obscure bleeding undergo capsule endoscopy, they should have a negative upper and lower endoscopy. The patient is then equipped with a wireless antenna and data recorder. The capsule endoscope is then swallowed. After 8–12 hours, the captured images are downloaded and analysed using dedicated software. Modern capsule endoscopy software has built-in automated diagnostic functions which are able to detect bleeding and other suspicious findings, making this process more efficient.
In SBE, an endoscope is inserted deep into the small intestine. The scope is then angulated to grasp the intestine. A splinting tube (overtube) is advanced over the endoscope to the rigid section. The balloon attached to the splinting tube is then inflated, the angulation of the scope is released and the splinting tube and scope are withdrawn to shorten the intestine. Repetition of this technique allows the intestine to be viewed in sections from both the antegrade (via the mouth) and the retrograde (via the anus) approaches. Haemorrhaging detected during SBE can then be cauterised or clipped.
Olympus offers pioneering solutions for capsule endoscopy and SBE. The EndoCapsule offers a supersensitive CCD with an ultracompact lens and automatic brightness control to give high-resolution images. A real-time viewer is available to check functionality and follow the capsule’s progress. Olympus also offers sophisticated image analysis software with special functions designed to save physicians’ time. Olympus supplies a range of equipment for SBE, including a scope combining high-resolution imaging with excellent manoeuvrability, a disposable sliding overtube for reliable, smooth insertion and an advanced balloon control unit for trouble-free operation.