The Role of Endoscopy in the Diagnosis and Management of Small Bowel Pathology in Children

Gastrointestinal bleeding in children: diagnostic approach

“…Abdominal ultrasonography, if necessary integrated by abdominal computed tomography (CT), is the first-line option to exclude surgical causes (e.g. intussusception, volvulus, masses) in ill-appearing patients with lower GIB and abdominal pain [ 32 ]. Ultrasonography (US) is relatively inexpensive, widely available, does not involve ionizing radiation and can provide dynamic assessment of bowel vascularization (Doppler) and peristalsis [ 33 , 34 ].…”

“…This imaging technique can identify active bleeding but also pinpoint its source, providing valuable guidance for therapeutic interventions. The advantages of CT include rapid acquisition within a few minutes and the ability to detect active bleeding as low as 0.3–0.5 ml/min [ 10 , 32 , 36 ].…”

“…Owing to the latter one, in case of persistent bleeding, another evaluation through capsule endoscopy as near as possible to the bleeding source and an improved bowel cleansing could become necessary [ 34 , 36 , 45 ]. Balloon-assisted enteroscopy or intraoperative enteroscopy may help classify and treat lesions detected by MR/enteroscopy or by capsule endoscopy [ 28 , 32 , 46 , 47 ]. Figure 3 outlines an algorithm guiding the approach to children with OGIB.…”