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Invited Commentary

Jeffrey L. Ponsky, MD
Arch Surg. 1996;131(3):277. doi:10.1001/archsurg.1996.01430150055011.
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The diagnosis and management of occult gastrointestinal hemorrhage has confounded physicians and surgeons for decades. Advances in gastrointestinal endoscopic technology, arteriography, and radionuclide scanning have permitted the accurate definition and, in some instances, treatment of causative lesions of the esophagus, stomach, duodenum, and colon. Thus, an aggressive approach has developed toward the treatment of patients with gastrointestinal hemorrhage.

Most bleeding lesions of the gastrointestinal tract are found within the reach of the flexible endoscope, and, thus, diagnosis and treatment with this modality have been highly successful. The method has generally yielded poor results in defining lesions of the small bowel. Radionuclide imaging, while extremely sensitive to the presence of bleeding, suffers from the inability to specifically localize lesions. Arteriography permits specific localization of lesions when hemorrhage is active but may fail when bleeding has slowed or ceased. The course of gastrointestinal hemorrhage is usually intermittent; thus, attempts at diagnosis by


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