Review Article

The Diagnosis and Investigation of Obscure Gastrointestinal Bleeding

K. Liu; A. J. Kaffes

Disclosures

Aliment Pharmacol Ther. 2011;34(14):416-423. 

In This Article

Intraoperative Enteroscopy

Intraoperative enteroscopy (IOE), once considered the gold standard for OGIB, has a diagnostic yield of between 70% and 100% in these patients.[37] In a prospective study comparing CE with IOE, the diagnostic yield of IOE in obscure overt bleeding, previous overt bleeding and obscure occult bleeding were 100%, 70.8% and 50% respectively.[38] Capsule endoscopy compared favourably detecting lesions found by IOE with good sensitivity (95%) and specificity (75%). However, a follow-up study of these OGIB patients performed by the same group found recurrent bleeding in over 25% despite treatment during time of IOE.[39]

The standard approach consists of gaining intra-abdominal access via a laparotomy or laparoscopy followed by creation of an enterotomy through which an endoscope is introduced. The passage of the enteroscope is assisted by the surgeon to achieve total enteroscopy. Surgically or laparoscopically assisted transoral and transanal approaches have also been described removing the need for an enterotomy. However, these approaches are time consuming and are less likely to achieve total enteroscopy.[37]

Intraoperative enteroscopy is associated with significant morbidity and mortality largely related to the laparoscopy, laparotomy or enterotomy. It should therefore be reserved for situations where CE, DBE or PE have been contraindicated, unsuccessful or technically difficult.[37]

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