title: Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?
abstract: BACKGROUND
  in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level.
  
  
  OBJECTIVE
  evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding.
  
  
  METHODS
  we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively.
  
  
  RESULTS
  with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy´s lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively.
  
  
  CONCLUSIONS
  intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal. pedromonsanto@gmail.com
authors.forename: Pedro
authors.initials: P
authors.lastname: Monsanto
authors.forename: Nuno
authors.initials: N
authors.lastname: Almeida
authors.forename: Clotilde
authors.initials: C
authors.lastname: Lérias
authors.forename: Pedro
authors.initials: P
authors.lastname: Figueiredo
authors.forename: Hermano
authors.initials: H
authors.lastname: Gouveia
authors.forename: Carlos
authors.initials: C
authors.lastname: Sofia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D058582:Double-Balloon Enteroscopy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome