UMMS Affiliation

Department of Surgery; Department of Medicine; Department of Medicine, Division of Gastroenterology; School of Medicine; Senior Scholars Program

Faculty Mentor

Dr. David R. Cave

Publication Date


Document Type



Digestive System Diseases | Gastroenterology | Medical Education | Surgery


Background: Primary small bowel lesions (SBLs) are rare entities that are difficult to characterize with modern endoscopic and radiographic techniques. This makes their diagnosis and management a significant challenge. Further, SBLs vary widely in pathology and gastrointestinal tract location. Therefore, it is important to review prior SBL cases to understand what factors were most beneficial in directing diagnostic approaches and subsequent treatments for these patients.

Purpose: To evaluate diagnostic modalities used and management practices of patients with SBLs at an advanced endoscopic referral center.

Methods: We analyzed patients undergoing surgical management for SBL from 2005-2015 at a single tertiary care center. Patients were stratified into gastrointestinal bleed/anemia (GIBA) or obstruction/pain (OP).

Results: One hundred and twelve patients underwent surgery after presenting with either GIBA (n=67) or OP (n=45). The mean age of our study population was 61.8 years and 45% were women. Patients with GIBA had a higher body mass index (30.0kg/m2 vs 24.9kg/m2), were more likely to have chronic or acute-on-chronic symptoms (100% vs 67%), and more often referred from outside hospitals (82% vs. 44%) (p

Conclusion: Management and identification of SBL is governed by presenting symptomatology. Optimal management includes VCE and IE for GIBA and CT scans for OP patients. Comprehensive evaluation may require referral to specialized centers.


Small bowel, Minimally-invasive surgery, Gastrointestinal bleed

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Copyright is held by the author(s), with all rights reserved.

DOI of Published Version


Journal/Book/Conference Title

2018 Senior Scholars Program Poster Presentation Day


David Stein participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School. His work was presented on Senior Scholars Program Poster Presentation Day at the University of Massachusetts Medical School, Worcester, MA, on May 2, 2018.

Related Resources

Study data was published in: Green J, Schlieve CR, Friedrich AK, Baratta K, Ma DH, Min M, Patel K, Stein D, Cave DR, Litwin DE, Cahan MA. Approach to the Diagnostic Workup and Management of Small Bowel Lesions at a Tertiary Care Center. J Gastrointest Surg. 2018 Jan 25. doi: 10.1007/s11605-018-3668-2. [Epub ahead of print] PubMed PMID: 29372393.