New Approach to Anemia and Occult Blood

To treat bleeding that occurs in the patient’s gastrointestinal tract historically has been a difficult challenge. Today, the physicians at Gastro Health have advanced tools and techniques to identify the site of a lesion and treat this potentially dangerous condition.

The typical signs of a bleeding problem include anemia, iron deficiency and blood in the stool, which is called occult blood. When the patient’s bleeding site cannot be found by upper endoscopy or colonoscopy, the condition is called occult gastrointestinal bleeding (OGIB). OGIB occurs in approximately 5% of patients with gastrointestinal bleeding.

Symptoms of OGIB include a change in the color of stools to black-tarry or even maroon, a drop in red blood cells (anemia) and low blood pressure, on occasion. Patients with OGIB may be admitted to the hospital several times for blood transfusions. But if nothing is found by an upper endoscopy or colonoscopy and the bleeding has stopped, the patient is sent home, only to have the condition recur. Several earlier research studies indicated the average time to diagnosis and treat OGIB was 2.7 years, and an average of 30 units of blood needed to be transfused.

In the early 20th century, patients used to have to swallow a rope with a heavy tip to propel it through the intestine into the small and large bowels. The rope was then tied to a camera, which was pulled through the GI tract to evaluate the bowels. Needless to say, this required general anesthesia, as did a later technique that involved navigating a small scope through the patient’s body.

Today, new techniques have been developed and deployed into practice that are safer, more comfortable and much more effective in locating and treating OGIB.
One of these techniques is capsule endoscopy, which involves using a camera with two batteries and a radio transmitter inside an 11x26mm pill. After the patient swallows the device in an outpatient center, it transmits up to 50,000 images to antennae worn on the patient’s abdomen, which in turn are stored on a hard drive. After an eight-hour period, the patient comes to the office, drops off the device and the 50,000 images are converted into a video that is read by the gastroenterologist. This technique has revolutionized small bowel endoscopy, which used to be considered a “black box” where the lack of a very long endoscope meant that no diagnosis or therapy could be done.

Since the advent of capsule endoscopy, another instrument was developed in Japan to treat lesions found in the bowel. This was the start of double-balloon, and then single-balloon enteroscopes, which use a sleeve-like device that has a balloon on its tip (the double-balloon scope, also has a balloon on the tip of the scope). The balloon serves as an anchoring device that opens up the small bowel, so the scope is able to advance deeper and through a small channel. This allows gastroenterologists to find and treat bleeding lesions or remove polyps or tumors in the small bowel. The Physician can also leave a tattoo, so if the patient requires surgery, the surgeon can easily find the area of the lesion in order to remove it.

Even more recently, a new kind of sleeve-like device has been developed by a Boston company. This device has a corkscrew-like shape on its tip. Instead of pushing and pulling to open the bowel, it uses the rotational ability of a corkscrew-like tip to achieve the same objective. The spiral will eventually be incorporated onto an endoscope and coupled to a motor, so the entire small bowel can be evaluated with a single procedure.

With balloon and spiral-assisted enteroscopy, cauterization of small bowel lesions can be easily achieved. When no other abnormalities are found – such as those that need surgical intervention – the patient’s iron and transfusion requirements drop dramatically. This substantially decreases the risk of repeated transfusions and the cost to the healthcare system. All of these advanced techniques are available at Gastro Health.