Complete intraoperative small-bowel endoscopy in the evaluation of occult gastrointestinal bleeding using the sonde enteroscope.
OBJECTIVE
To review our experience with intraoperative small-bowel Sonde enteroscopy in evaluating occult bleeding in the small intestine.


METHODS
Retrospective study with 100% follow-up.


METHODS
University-affiliated, tertiary-care teaching hospital.


METHODS
Sixteen consecutive patients referred with occult gastrointestinal bleeding in whom esophagogastro-duodenoscopy , push enteroscopy, and colonoscopy had failed to identify the source of bleeding. Fourteen of the 16 patients had required one or more transfusions.


METHODS
Completeness of visualization, diagnostic accuracy, and complications of the procedure and follow-up for recurrent bleeding.


RESULTS
In all 16 patients, intraoperative Sonde enteroscopy allowed visualization of the entire small bowel. In 14 of the 16, it revealed the cause of bleeding, which was ileal angiodysplasia in three patients, ileal ulcers in six patients, neoplasia in two patients, and ileal ulcers caused by Crohn's disease, small-intestinal enteropathy and varices caused by portal hypertension, and radiation stricture in one patient each. Two patients had normal small bowel mucosa. The patients with mucosal disease underwent small-bowel resection or oversewing of bleeding sites. Two surgical complications occurred: prolonged postoperative ileus (one patient) and small-bowel obstruction that resolved without surgery (one patient). Two of the patients with angiodysplasia had recurrent bleeding postoperatively.


CONCLUSIONS
Intraoperative Sonde enteroscopy is safe and effective in localizing small-intestinal bleeding sites, providing complete visualization of the small-bowel mucosa without enterotomy while avoiding the trauma that can be caused by push endoscopy. It is the diagnostic assessment of choice in selected patients with occult gastrointestinal bleeding of presumed small-bowel origin.
Lopez
M J
MJ
Department of Surgery, St Elizabeth's Medical Center of Boston, Massachusetts, USA.
Cooley
J S
JS
Petros
J G
JG
Sullivan
J G
JG
Cave
D R
DR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020776:Endoscopes, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis*; D007421:Intestine, Small / Q000473:pathology*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies