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.