Intraoperative Enteroscopy For The Diagnosis Of Bleeding From Unknown Origin. A Series Of 58 Consecutive Patients

Background/Aims: Despite the use of standard endoscopy techniques a minority of patients with loss of blood from the gastrointestinal tract will not have a definitive diagnosis. Capsule endoscopy might have the potential to close this diagnostic gap. We analysed the results and complications of intraoperative enteroscopy. Patients/Methods: Fifty-eight consecutive patients (mean age: 67 yrs.; 27 male) underwent intraoperative enteroscopy. The indication was bleeding from unknown origin in all patients. All of these patients had abdominal ultrasound and at least one complete endoscopic work-up of the GI-tract including EGD, push- or sonde-type enteroscopy and colonoscopy. Most of them had a barium enema of the small intestine and about 30% of the patients had intraarterial angiography. Intraoperative enteroscopy was performed in general anaesthesia using a standard colonoscope (e.g., Olympus CF-140). Results: The mean minimal hemoglobine level of the 58 pts. was 5.9 g/dl and 37 pts. (63.8%) needed transfusion of packed erythrocytes. A bleeding source was detected in 75.8% of the patients during intraoperative enteroscopy. Thirty-five pts. (60.3%) had angiodysplasias of the small intestine and a tumor was found in nine additional patients (15.5%). Angiodysplasias were treated by argon-plasma-coagulation (n=17 pts.), surgical suture (n=18 pts.) or surgical resection (n=4; patients with multiple angiodysplasias in a well-defined area of the ileum). In the nine patients with a tumor the surgical resection was performed after the intraoperative enteroscopy during the same session. No severe complications were found related to the intraoperative enteroscopy. Conclusion: While overwhelming enthusiasm for capsule endoscopy intraoperative enteroscopy still remains the gold standard for the diagnosis of severe bleeding from unknown origin. The diagnostic efficacy is high when the selection of patient is well-defined and the intraoperative setting provides the opportunity for immediate therapy.