Diagnosis of obscure gastrointestinal bleeding by intra-operative enteroscopy in 81 consecutive patients.
OBJECTIVE
To analyze the results and complications of intra-operative enteroscopy (IOE) by investigating a series of selected patients with bleeding suspected to originate from the small intestine.


METHODS
Eighty-one patients (mean age: 65 years) including 40 males (49.4%) and 41 females (50.6%) with obscure gastrointestinal bleeding underwent IOE between 1990 and 2004. The patients were identified from a database and data were selected from the patients' charts retrospectively. All the patients had undergone at least one non-diagnostic esophagogastroduodenoscopy, colonoscopy, standard enteroscopy and a negative abdominal ultrasound scan before IOE.


RESULTS
The median minimal hemoglobin level in the patients was 59 + 15 g/L and 72.8% of the patients required transfusion of packed erythrocytes previously. A bleeding source was detected in 68 (84%) of the patients during IOE. Angiodysplasiae were found in 44 patients (54.3%) and 9 patients (11.1%) were affected by ulcers in the small intestine. A tumor in the small intestine was detected in another 6 patients. The treatment consisted of argon-plasma-coagulation, surgical suture or limited resection in most of the patients.


CONCLUSIONS
Intra-operative enteroscopy is still used for the diagnosis of suspected small bowel bleeding. Recent developments such as wireless capsule endoscopy and double balloon enteroscopy, may lead to the replacement of IOE in the future.
Department of Medicine C, Klinikum der Stadt Ludwigshafen gGmbH, Bremserstrasse 79,67063 Ludwigshafen, Germany. jakobsr@klilu.de
Ralf
R
Jakobs
Dirk
D
Hartmann
Claus
C
Benz
Dieter
D
Schilling
Uwe
U
Weickert
Axel
A
Eickhoff
Klaus
K
Schoenleben
Juergen F
JF
Riemann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged