Taiwan practical consensus for evaluation and management of small-bowel bleeding

Chia-Jung Kuo^{1

2

3}, Wei-Kuo Chang^{3

4}, Chen-Shuan Chung^{3

5

6}, Tien-Yu Huang^{3

4}, Chih-Sheng Hung^{3

7

8

9

10}, Wei-Chen Tai^{3

11}, Ming-Yao Su^{2

3

12}, Chao-Hung Kuo^{3

13

14}, Chia-Long Lee^{3

7}, Deng-Chyang Wu^{3

13

14}, Horng-Yuan Wang^{3

15

16

17}, Cheng-Hsin Chu^{3

15

16

17}, Puo-Hsien Le^{1

2

3}, Hsi-Chang Lee^{3

18}, Jen-Wei Chou^{3

19}, Wei-Pin Lin^{1

2

3}, Ching-Pin Lin^{3

20

21}, Chia-Hung Tu^{3

22}, Cheuk-Kay Sun^{3

23}, Chen-Wang Chang^{3

15

16

17}, Wen-Hung Hsu^{3

13

14}, Chih-Yen Chen^{3

24

25}, Yang-Yuan Chen^{3

26

27}, Chi-Ming Tai^{3

28

29}, Hsu-Heng Yen^{3

26

27}, Jiing-Chyuan Luo^{3

24

30}, Kuan-Yang Chen^{3

18}, Cheng-Tang Chiu^{1

2

3}

Affiliations

¹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
² Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC.
³ Taiwan Association for the Study of Intestinal Disease, Taoyuan, Taiwan, ROC.
⁴ Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
⁵ Program A, Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, ROC.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
⁷ Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC.
⁸ School of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
⁹ School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC.
¹⁰ School of Medicine, National Tsing Hua University, Hsinchu, Taiwan, ROC.
¹¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
¹² Department of Gastroenterology and Hepatology, New Taipei Municipal Tu Cheng Hospital (Built and Operated by Change Gung Medical Foundation), New Taipei City, Taiwan, ROC.
¹³ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
¹⁴ Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
¹⁵ Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC.
¹⁶ MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC.
¹⁷ Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC.
¹⁸ Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
¹⁹ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC.
²⁰ Division of Hepatology and Gastroenterology, Department of Internal Medicine, School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
²¹ School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
²² Department of Integrated Diagnostic & Therapeutic, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
²³ Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
²⁴ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
²⁵ Institute of Emergency and Critical Medicine, and School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
²⁶ Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan, ROC.
²⁷ Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
²⁸ Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, ROC.
²⁹ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan, ROC.
³⁰ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.

PMID: 41559881
PMCID: PMC13004205
DOI: 10.1097/JCMA.0000000000001345

Practice Guideline

Taiwan practical consensus for evaluation and management of small-bowel bleeding

Chia-Jung Kuo et al. J Chin Med Assoc. 2026.

. 2026 Mar 1;89(3):204-211.

doi: 10.1097/JCMA.0000000000001345. Epub 2026 Jan 21.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
² Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC.
³ Taiwan Association for the Study of Intestinal Disease, Taoyuan, Taiwan, ROC.
⁴ Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
⁵ Program A, Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, ROC.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
⁷ Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC.
⁸ School of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
⁹ School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC.
¹⁰ School of Medicine, National Tsing Hua University, Hsinchu, Taiwan, ROC.
¹¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
¹² Department of Gastroenterology and Hepatology, New Taipei Municipal Tu Cheng Hospital (Built and Operated by Change Gung Medical Foundation), New Taipei City, Taiwan, ROC.
¹³ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
¹⁴ Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
¹⁵ Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC.
¹⁶ MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC.
¹⁷ Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC.
¹⁸ Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
¹⁹ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC.
²⁰ Division of Hepatology and Gastroenterology, Department of Internal Medicine, School of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
²¹ School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
²² Department of Integrated Diagnostic & Therapeutic, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
²³ Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
²⁴ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
²⁵ Institute of Emergency and Critical Medicine, and School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
²⁶ Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan, ROC.
²⁷ Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC.
²⁸ Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, ROC.
²⁹ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan, ROC.
³⁰ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.

PMID: 41559881
PMCID: PMC13004205
DOI: 10.1097/JCMA.0000000000001345

Abstract

Small-bowel bleeding, accounting for 5% to 10% of gastrointestinal bleeding episodes, presents a distinct diagnostic challenge due to the organ's length and anatomical complexity. Over recent years, the management of small-bowel bleeding has significantly evolved, driven by advancements in both diagnostic and therapeutic technologies. This Taiwan Association for the Study of Intestinal Diseases (TASID) practical consensus integrates local epidemiology, up-to-date diagnostic advances, including early small-bowel capsule endoscopy, and emerging treatments for vascular lesions such as angiodysplasia. This practical consensus is divided into four major parts, including: (I) terminology regarding small-bowel bleeding and differential diagnosis, (II) evaluation of suspected small-bowel bleeding, (III) endoscopy for small-bowel bleeding, and (IV) medical treatment. Clinicians should be equipped to identify common causes of small-bowel bleeding, understand the advantages and limitations of various evaluation methods, and apply a stepwise, evidence-based approach in managing these patients.

Keywords: Capsule endoscopy; Consensus; Enteroscopy; Small-bowel bleeding.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: Dr. Jiing-Chyuan Luo, an editorial board member at Journal of the Chinese Medical Association , had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

Figures

**Fig. 1**
Practice-oriented diagnostic and therapeutic pathway for suspected small-bowel bleeding.

See this image and copyright information in PMC

References

1. Zuckerman GR, Prakash C, Askin MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000;118:201–21. - PubMed
1. Havlichek DH, III, Kamboj AK, Leggett CL. A practical guide to the evaluation of small bowel bleeding. Mayo Clin Proc 2022;97:146–53. - PubMed
1. García-Compeán D, Del Cueto-Aguilera Á N, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: a critical review and view points. World J Gastroenterol 2019;25:2549–64. - PMC - PubMed
1. Gunjan D, Sharma V, Rana SS, Bhasin DK. Small bowel bleeding: a comprehensive review. Gastroenterol Rep (Oxf) 2014;2:262–75. - PMC - PubMed
1. Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL. Meckel’s diverticulum. J Am Coll Surg 2001;192:658–62. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Taiwan practical consensus for evaluation and management of small-bowel bleeding

Affiliations

Taiwan practical consensus for evaluation and management of small-bowel bleeding

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical