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

Research output: Contribution to journalArticle

Abstract

Background: Intraoperative enteroscopy (IE) is an effective diagnostic and therapeutic tool in selected patients with obscure GI bleeding. Enterotomy or the use of a colonoscope orally and then rectally has been necessary to completely inspect the small bowel. However, the development of dedicated enteroscopes allows the complete inspection of the small bowel using the peroral route. Aim: Assess the diagnostic yield, patient outcome, and success in reaching the terminal ileum using a video enteroscope, Olympus SIF-100 (working length: 2175mm). Methods: 11 patients underwent IE for obscure GI bleeding, 2 patients with a known source (AVM's), underwent evaluation to determine extent. Mean transfusion for each patient was 17 units. 8 patients presented with melena, 2 with hematochezia, and 3 with brown hemoccult positive stools. Each patient on average had 3 EGD's, 2 colonoscopies, 1 tagged RBC scan, 1 small bowel enema, and 1.5 push enteroscopies as prior work up. There were 10 females and 3 males with a mean age of 66 (range 54-76 yrs). Mean duration of bleeding was 4.5 years (range 0.5-12 yrs). Range of follow up 7 to 42 months. Results: Mean endoscopy time 71 minutes (range 45-150 min) and operative time of 168 minutes (range 90-270 min). Mean hospital stay 9 days (range 7-13 days). Terminal Bleeding source Surgical No further ileum reached identified therapy bleeding 12/13 8/13 8/13 8/13 (jejunal stricture (lymphoma 1, (resected 5, in 1 patient) carcinoid 1, AVM's 6) oversewn 3) Complications included serosal tears 3 (one requiring resection), post-operative CHF 2, azotemia 1, and prolonged ileus 1. Conclusions: The terminal ileum was reached 92% of the time with IE. Major operative morbidity was seen in one patient, and there was no mortality. The diagnostic yield of IE was 61% with 61% of patients having no further bleeding.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume47
Issue number4
Publication statusPublished - 1998

    Fingerprint

ASJC Scopus subject areas

  • Gastroenterology

Cite this