Skip to main contentLast updated: 12-Nov-2026
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Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
If bleeding goes on after a normal upper scope and colonoscopy, the source may sit in the small bowel. That part is about five metres long, and ordinary scopes cannot reach it.
A swallowed capsule camera is the usual first test. It finds the spot but cannot treat it. A balloon enteroscope then reaches the spot and treats it.
Before any capsule, a narrowing of the bowel must be ruled out. Otherwise the capsule can get stuck.
This post explains the small bowel tests. For the full picture of causes and treatment, see our lower GI bleeding treatment page.
Only after the reachable parts are cleared. A careful repeat upper scope and colonoscopy come first, because many hidden bleeds are simply missed ones.
Doctors used to call this problem obscure bleeding. Today the term small bowel bleeding is used once the stomach and colon are cleared. Two patterns are seen. In one, you see blood or black stool. In the other, you only have anaemia and a stool test that shows hidden blood.
The repeat scope often finds a small erosion in a hiatus hernia or a tiny vessel in the stomach. It may also find a lesion in the right colon, hidden before by poor bowel prep. Finding these saves you an expensive test. Bring your old scope reports, so we can judge how complete the first look was.
You swallow a pill-sized camera. It takes pictures as it travels through the small bowel for about eight to twelve hours. You pass it in the stool.
There is no sedation and no tube. You go about your day while a belt records the pictures. A specialist then reads the video. The capsule is the usual first test for small bowel bleeding. It gives clearer answers when done early, during or soon after a bleed.
It has two limits. It cannot take a biopsy or treat the spot. It also tells you the place only roughly, by how far along the journey the picture was taken.
| Test | What it does | What it cannot do |
|---|---|---|
| Capsule camera | Swallowed, no sedation, surveys the whole small bowel | Cannot treat or biopsy; place is approximate |
| Balloon enteroscopy | Reaches the spot, treats it, takes a biopsy, marks it with a tattoo | Needs sedation or anaesthesia; longer; may need two routes |
| CT or MR enterography | Shows lumps, narrowings and wall thickening; safe when a capsule is not | Can miss flat surface lesions and tiny vessels |
A capsule must not be swallowed if the bowel may be narrowed. It can lodge behind the narrowing and cause a blockage.
In these patients, a dissolving test capsule is swallowed first. It has the same size as the real one. If it passes whole, the bowel is open enough. If not, it dissolves harmlessly. A CT or MR scan of the small bowel can be used instead.
It is a long scope with a sleeve and balloons that fold the small bowel onto the scope, step by step. It reaches deep and lets the doctor treat what the capsule found.
There are double balloon, single balloon and spiral versions. All of them can seal a bleeding vessel with heat or place a clip. They can also take a biopsy and tattoo the spot for a later operation.
The capsule picture time guides the route. A spot found early in the journey is reached through the mouth. A spot found late is reached through the back passage.
The test is longer than a normal scope. It carries a small risk of a tear in the bowel wall or pancreas inflammation. For this reason it is used to treat a known spot, not as a blind search.
A normal capsule does not rule out a lesion. A vessel that bleeds now and then can be missed on the day.
If bleeding returns, the capsule is repeated soon after the bleed. A CT or MR scan can then look for a lump the camera could not see. In young people, a Meckel pouch scan is also considered. The last resort is a combined operation and scope, kept for a heavy bleed that nothing else has located.
Capsule and balloon enteroscopy are costly and found mainly in bigger centres. A careful second look plus a CT scan of the small bowel often comes first.
If a lesion is found, a usual small bowel cause is a patch of fragile vessels, called angiodysplasia. It tends to bleed again, so iron and sometimes a tablet like thalidomide are added to the scope treatment. This is decided case by case, with strict care in young women. Read more in our post on angiodysplasia and Dieulafoy lesion.
Those scopes cannot reach the small bowel, which is about five metres long. Some lesions are also missed on the first look. So a careful repeat of both scopes often comes first.
It is a pill-sized camera you swallow. It takes pictures of the small bowel for eight to twelve hours and passes out in the stool. No sedation is needed.
No. It only finds the spot and shows roughly where it lies. Treatment needs a balloon enteroscopy or another procedure.
Yes, if the bowel is narrowed by Crohn disease, tuberculosis, radiation or tablet-related scarring. A dissolving test capsule or a CT or MR scan is used first to check.
It reaches the spot the capsule found. The doctor can seal a bleeding vessel, clip it, take a biopsy and tattoo the place for later.
It depends on where the capsule found the lesion. An early spot is reached by mouth and a late spot by the back passage. Sometimes both routes are used on separate days.
A normal capsule does not rule out a lesion. The test is repeated soon after a new bleed, or a CT or MR scan of the small bowel is added.
No. They are costly and mostly in larger centres. A careful repeat scope and a CT scan of the small bowel often come first. Referral follows if a lesion is confirmed.
For the whole picture, start at the lower GI bleeding page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Still bleeding, or still anaemic, after a normal endoscopy and colonoscopy? Dr Harsh Shah, a surgeon, reads your earlier scope reports with you and decides whether the small bowel needs a look. He also checks whether a capsule is safe for you. Bring every report, scan and tablet strip. You can also call, or message us on WhatsApp. Call For Appointment Book on WhatsApp Tapping Book on WhatsApp will likely open the WhatsApp app on your phone.
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