A. Zaman et al., Total peroral intraoperative enteroscopy for obscure GI bleeding using a dedicated push enteroscope: diagnostic yield and patient outcome, GASTROIN EN, 50(4), 1999, pp. 506-510
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.