[Diagnostic and therapeutic strategies for small-bowel gastrointestinal bleeding when initial upper endoscopy and colonoscopy are unremarkable].

Suspected small bowel bleeding is defined as a gastrointestinal bleeding, overt or occult (iron-deficiency anemia), with unremarkable high-quality upper endoscopy and colonoscopy. The main causes are vascular lesions (angiodysplasia) and inflammatory lesions (Crohn's disease). Diagnosis is primarily based on capsule endoscopy, which has an optimal yield if performed within 48 hours on bleeding onset. Deep enteroscopy often allows targeted treatment, but its availability is limited. If the capsule endoscopy is not contributive as well, the bleeding is referred to as obscure gastrointestinal bleeding. Management is not consensual. Treatment of the anemia and surveillance may be an option. It is reasonable course of action to repeat endoscopies, optimizing them, particularly in the event of recurrence.