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 therapeutic method in selected patients with obscure gastrointestinal (GI) bleeding. The passage of a colonoscope orally and then rectally or the use of multiple enterotomies, has been used to completely inspect the small bowel. However, the development of dedicated enteroscopes allows complete inspection using the peroral route. Aim: The aim of the study was to assess the diagnostic yield, patient outcome, and success in reaching the terminal ileum using a video enteroscope passed orally during intraoperative enteroscopy. Methods: The hospital charts of 12 patients who underwent intraoperative enteroscopy for G bleeding of obscure origin and 2 patients with a known source (angioectasias) who underwent evaluation to determine extent were retrospectively analyzed. Results: The terminal ileum was reached in 13 of 14 patients (jejunal stricture in I patient). Of the patients with bleeding of obscure origin (n = 12) a source was identified in 7 (angioectasias 4, lymphoma 1, carcinoid 1, nevuslike 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 patients who had no source identified during intraoperative enteroscopy. Of the 2 patients undergoing intraoperative enteroscopy to evaluate extent of angioectasias, additional angioectasias were found in I patient; both patients underwent surgical resection, and I patient had recurrent bleeding. Complications included serosal tears, 3 (2 requiring resection); avulsion of superior 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 intraoperative enteroscopy. For patients with GI bleeding of obscure origin the diagnostic yield of intraoperative enteroscopy was 58%. Major operative morbidity occurred in 4 patients.