Total peroral intraoperative enteroscopy for obscure GI bleeding using a dedicated push enteroscope: diagnostic yield and patient outcome

Background: Intraoperative enteroscopy is an effective diagnostic and thera peutic method in selected patients with obscure gastrointestinal (GI) bleed ing. The passage of a colonoscope orally and then rectally or the use of mu ltiple enterotomies, has been used to completely inspect the small bowel. H owever, the development of dedicated enteroscopes allows complete inspectio n using the peroral route. Aim: The aim of the study was to assess the diagnostic yield, patient outco me, and success in reaching the terminal ileum using a video enteroscope pa ssed orally during intraoperative enteroscopy. Methods: The hospital charts of 12 patients who underwent intraoperative en teroscopy for GI bleeding of obscure origin and 2 patients with a known sou rce (angioectasias) who underwent evaluation to determine extent were retro spectively analyzed. Results: The terminal ileum was reached in 13 of 14 patients (jejunal stric ture in 1 patient). Of the patients with bleeding of obscure origin (n = 12 ) a source was identified in 7 (angioectasias 4, lymphoma 1, carcinoid 1, n evuslike lesion 1). Surgical therapy was performed in these 7 patients and resulted in no further bleeding in 5. Bleeding recurred in 4 of the 5 patie nts who had no source identified during intraoperative enteroscopy. Of the 2 patients undergoing intraoperative enteroscopy to evaluate extent of angi oectasias, additional angioectasias were found in 1 patient; both patients underwent surgical resection, and 1 patient had recurrent bleeding. Complic ations included serosal tears, 3 (2 requiring resection); avulsion of super ior mesenteric vein, 1; postoperative congestive heart failure, 2; azotemia , 1; and prolonged ileus, 1. There were no deaths. Conclusions: The terminal ileum was reached 93% of the time with intraopera tive enteroscopy. For patients with GI bleeding of obscure origin the diagn ostic yield of intraoperative enteroscopy was 58%. Major operative morbidit y occurred in 4 patients.