Small bowel bleeding accounts for 5% of all gastrointestinal bleeding events. However, access to the small bowel remains challenging given its length of nearly 12 to 20 feet. Novel techniques such as wireless capsule endoscopy and balloon enteroscopy have allowed gastroenterologists to now visualize and perform therapies deep within the small intestine.

The University of Chicago Medicine was the first center in the Midwest to perform double balloon enteroscopy in 2004 and since that time has become an international leader in the management of small bowel bleeding. Led by Dr. Carol Semrad, UChicago Medicine has a multidisciplinary program — in partnership with radiology and general surgery — focused on the identification and management of small bowel bleeding.

The most common cause of small bowel bleeding is abnormal blood vessels (angioectasias). These small, fragile blood vessels develop on the inside of the intestinal surface with age and often with underlying comorbidities such as valvular heart disease, chronic kidney disease and lung disease. Other causes of bleeding within the small intestine include ulcers due to non-steroidal anti-inflammatory drugs (NSAIDs) or Crohn's disease, polyps and more rarely tumors.

Bleeding from the small intestine can progress slowly, leading to iron deficiency anemia or, in the case of brisk bleeding, it can lead to bleeding from the rectum (hematochezia) or dark tarry stools (melena). Most commonly, bleeding from the small intestine is suspected if no other causes of blood loss are identified on an upper endoscopy or colonoscopy.

Access to the small bowel has always been limited by its length and angular shape. Wireless capsule endoscopy systems now allow for visualization of the small bowel using a swallowed camera that transmits images to a small video recorder. The camera — which is housed in a small pill — takes over 50,000 images as it travels through the stomach and small intestine evaluating for causes of small bowel bleeding. The images are transmitted to a small video recorder worn on a belt which can be uploaded and viewed by the gastroenterologist.

Specialized computed tomography (CT or CAT) scans can also help diagnose small bowel bleeding because of their improved visualization of diverticula, tumors and of the blood vessels that surround the small intestine.

Small Bowel Bleeding Treatment Options

The length of a typical scope used by gastroenterologists to diagnose and treat bleeding within the stomach and colon can limit therapy deep within the small intestine. Specialized scopes called double balloon enteroscopy systems allow for the treating gastroenterologist to inch their way into the small bowel with a series of balloons attached to the end of the scope.

This allows for non-invasive access into the small bowel to treat bleeding vascular lesions using electricity (argon plasma coagulation or bipolar coagulation) or small metal clips placed over the bleeding source. If polyps are present, we can also remove them during the procedure using snare techniques. If additional abnormalities are spotted, we can mark them with tattoo ink to enhance visualization for a surgeon during a surgical resection.

Comprehensive Care from a Team of Specialists

Since 2003, the University of Chicago Medicine has been an internationally recognized for the diagnosis and management of small bowel bleeding and as one of leading organizations in training physicians to perform double enteroscopy.

Given the wide range of causes and underlying conditions that can lead to small bowel bleeding, UChicago Medicine has created a multidisciplinary team consisting of gastroenterologists, surgeons, radiologists and pathologists dedicated to the diagnosis and management of small bowel bleeding.

Small Bowel Bleeding Specialists