COMPLETE INTRAOPERATIVE SMALL-BOWEL ENDOSCOPY IN THE EVALUATION OF OCCULT GASTROINTESTINAL-BLEEDING USING THE SONDE ENTEROSCOPE

Objective: To review our experience with intraoperative small-bowel So nde enteroscopy in evaluating occult bleeding in the small intestine. Design: Retrospective study with 100% follow-up. Setting: University-a ffiliated, tertiary-care teaching hospital. Patients: Sixteen consecut ive patients referred with occult gastrointestinal bleeding in whom es ophagogastroduodenoscopy, push enteroscopy, and colonoscopy had failed to identify the source of bleeding. Fourteen of the 16 patients had r equired one or more transfusions. Main Outcome Measurer: Completeness of visualization, diagnostic accuracy, and complications of the proced ure and follow-up for recurrent bleeding. Results: In all 16 patients, intraoperative Sonde enteroscopy allowed visualization of the entire small bowel. In 14 of the 16, it revealed the cause of bleeding, which was ileal angiodysplasia in three patients, ileal ulcers in six patie nts, neoplasia in two patients, and ileal ulcers caused by Crohn's dis ease, small-intestinal enteropathy and varices caused by portal hypert ension, and radiation stricture in one patient each. Two patients had normal small-bowel mucosa. The patients with mucosal disease underwent small-bowel resection or oversewing of bleeding sites. Two surgical c omplications occurred: prolonged postoperative ileus (one patient) and small-bowel obstruction that resolved without surgery (one patient). Two of the patients with angiodysplasia had recurrent bleeding postope ratively. Conclusions: Intraoperative Sonde enteroscopy is safe and ef fective in localizing small-intestinal bleeding sites, providing compl ete visualization of the small-bowel mucosa without enterotomy while a voiding the trauma that can be caused by push endoscopy. It is the dia gnostic assessment of choice in selected patients with occult gastroin testinal bleeding of presumed small-bowel origin.