title: Role of intraoperative enteroscopy in the management of obscure gastointestinal bleeding at the time of video-capsule endoscopy.
abstract: BACKGROUND
  This study aimed at evaluating the role of intraoperative enteroscopy (IOE) for the management of obscure gastrointestinal (GI) bleeding in patients who had been preoperatively explored by video-capsule endoscopy (VCE).
  
  
  METHODS
  Eighteen patients who underwent IOE for obscure GI bleeding were prospectively recorded between November 2000 and January 2007. The bleeding site was preoperatively localized by VCE in the small bowel in 15 patients, but the origin of bleeding remained unknown in 3 patients.
  
  
  RESULTS
  In the 3 patients with negative VCE, IOE was normal, but intraoperative conventional endoscopy identified gastric (n = 1) and colonic (n = 2) lesions. Among the 15 patients with VCE positive for small-bowel lesions, laparotomy and IOE yielded localization and treatment (surgical n = 11 and endoscopic n = 2) guidance for 13 of 15 (87%) lesions. At median 19-month follow-up, 3 bleeding recurrences (3 of 15 [20%]) were recorded, resulting in a 73% therapeutic efficacy of IOE.
  
  
  CONCLUSIONS
  IOE remains useful for the management of obscure GI bleeding when preoperative VCE is positive for small-bowel lesions that are not reachable by nonoperative enteroscopy. When VCE is negative, new conventional endoscopy should be proposed instead of IOE.
authors.affiliation: Department of General and Digestive Surgery, AP-HP European, Georges Pompidou University Hospital, Paris, France. richard.douard@hop.egp.ap-hop-paris.fr
authors.forename: Richard
authors.initials: R
authors.lastname: Douard
authors.forename: Philippe
authors.initials: P
authors.lastname: Wind
authors.forename: Anne
authors.initials: A
authors.lastname: Berger
authors.forename: Thibaut
authors.initials: T
authors.lastname: Maniere
authors.forename: Bruno
authors.initials: B
authors.lastname: Landi
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
authors.forename: Paul-Henri
authors.initials: PH
authors.lastname: Cugnenc
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D007421:Intestine, Small; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome