Background <p>To explore the value and safety of emergency enteroscopy (EES) in the treatment of patients with small bowel bleeding (SBB), and to analyze the etiological characteristics of SBB patients.</p> Methods <p>We collected the clinical data of 157 patients who were diagnosed as SBB and underwent emergency enteroscopy in the Sixth Affiliated Hospital of Sun Yat-sen University from May 2021 to July 2023, analyzing the results of diagnosis and treatment, as well as the occurrence of complications and follow-up.</p> Results <p>A total of 157 patients (119 males and 38 females) were included in the study, aged 7–83 (44.85 ± 17.86) years, and the disease duration was 1–9 (3.20 ± 2.20) days. There were 42 patients who underwent transoral enteroscopy, 29 patients who underwent transanal enteroscopy, and 86 patients who underwent both accesses. The diagnostic rate of EES was 90.4% (142/157). The etiology of SBB was small bowel ulcer (<i>n</i>  = 37, 23.60%), small bowel stromal tumor (n = 11, 7.00%), post-surgical anastomotic hemorrhage (<i>n</i>  = 20, 12.70%), vascular malformations (<i>n</i> = 23, 14.60%), diverticulum of the small bowel (<i>n</i> = 29, 18.5%), and hemangioma of the small bowel (<i>n</i> = 22, 14.0%). The median follow-up time of SBB patients was (16.38 ± 7.97) months with a range of 8–35&#xa0;months.</p> Conclusions <p>EES is safe and effective for the diagnosis of SBB and endoscopic treatment. The etiology of SBB is more common with small bowel ulcers, small bowel diverticula, vascular malformations, and hemangiomas.</p>