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Complete Intraoperative Small-Bowel Endoscopy in the Evaluation of Occult Gastrointestinal Bleeding Using the Sonde Enteroscope

Complete Intraoperative Small-Bowel Endoscopy in the Evaluation of Occult Gastrointestinal... Abstract Objective: To review our experience with intraoperative small-bowel Sonde enteroscopy in evaluating occult bleeding in the small intestine. Design: Retrospective study with 100% follow-up. Setting: University-affiliated, tertiary-care teaching hospital. Patients: Sixteen consecutive patients referred with occult gastrointestinal bleeding in whom esophagogastroduodenoscopy, push enteroscopy, and colonoscopy had failed to identify the source of bleeding. Fourteen of the 16 patients had required one or more transfusions. Main Outcome Measures: 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 radiotion 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.(Arch Surg. 1996;131:272-277) References 1. Szold A, Katz LB, Lewis BS. Surgical approach to occult gastrointestinal bleeding . Am J Surg . 1992;163:90-93.Crossref 2. Lewis BS. Small intestinal bleeding . Gastroenterol Clin North Am . 1994;23:6791. 3. Dykman DD, Killian SE. Initial experience with the Pentax VSBOP2900 enteroscope . Am J Gastroenterol . 1993:88:570-573. 4. Berner JS, Mauer K, Lewis B. Push and Sonde enteroscopy for the diagnosis of obscure gastrointestinal bleeding . Am J Gastroenterol . 1994;89:2139-2142. 5. Foutch PG, Sawyer R, Sanowski R. Push-enteroscopy for diagnosis of patients with gastrointestinal bleeding of obscure origin . Gastrointest Endosc . 1990;36:337-341.Crossref 6. Lewis B, Waye J. Small bowel enteroscopy: a comparison of findings with push and Sonde enteroscopy in 81 patients with Gl bleeding of obscure origin . Gastrointest Endosc . 1988;34:207-211. 7. Messer J, Romeu J, Waye J, et al. The value of proximal jejunoscopy in unexplained gastrointestinal bleeding . Gastrointest Endosc . 1984;30:151. 8. Lewis BS, Waye JD. Chronic gastrointestinal bleeding of obscure origin: role of small bowel enteroscopy . Gastroenterology . 1988;94:1117-1120. 9. Bombeck CT. Intraoperative esophagoscopy, gastroscopy, colonoscopy, and endoscopy of the small bowel . Surg Clin North Am . 1975;55:135-142. 10. Apelgren K, Vargish T, Al-Kawas F. Principles for use of intraoperative enteroscopy for hemorrhage from the small bowel . Am Surg . 1988:54:85-87. 11. Bowden T. Endoscopy of the small intestine . Surg Clin North Am . 1989:19: 1237-1247. 12. Desa L, Ohri S, Hutton K, et al. Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel origin . Br J Surg . 1991;78: 192-195.Crossref 13. Flickinger E, Stanforth C, Sinar D, et al. Intraoperative video panendoscopy for diagnosing sites of chronic intestinal bleeding . Am J Surg . 1989;157:137-144.Crossref 14. Frank M, Brandt L, Boley S. latric submucosal hemorrhage: a pitfall of intraoperative endoscopy . Am J Gastroenterol . 1981;75:209-210. 15. Lau W, Wong S, Yuen W, et al. Intraoperative enteroscopy for bleeding angiodysplasias of the small intestine . Surg Gynecol Obstet . 1989;168:341-344. 16. Mathus-Vliegen E, Tytgat G. Intraoperative endoscopy: technique, indications and results . Gastrointest Endosc . 1986;32:381-384.Crossref 17. Strodel W, Eckhauser F, Knol J, et al. Intraoperative fiberoptic endoscopy . Am Surg . 1984;50:340-344. 18. Lewis B, Wenger J, Waye J. Intraoperative enteroscopy versus small bowel enteroscopy in patients with obscure GI bleeding . Am J Gastroenterol . 1995; 86:171-174. 19. Ress AM, Benacci JC, Sarr MG. Efficacy of intraoperative enteroscopy in diagnosis and prevention of recurrent, occult gastrointestinal bleeding . Am J Surg . 1992;163:94-99.Crossref 20. Lau WY, Yuen WK, Chu KW, Poon GP, Li AKC. Obscure bleeding in the gastrointestinal tract originating in the small intestine . Surg Gynecol Obstet . 1992: 174:119-124. 21. Hoffman JS, Cave DR, Birkett D. Intra-operative enteroscopy with a Sonde intestinal fiberscope . Gastrointest Endosc . 1994;40:229-230.Crossref 22. Gostout CJ. Improving the withdrawal phase of Sonde enteroscopy with the 'push-away' method . Gastrointest Endosc . 1993;39:69-72.Crossref 23. Chong J, Tagle M, Barkin JS, Reiner DK. Small bowel push-type fiberoptic enteroscopy for patients with occult gastrointestinal bleeding or suspected small bowel pathology . Am J Gastroenterol . 1994;89:2143-2146. 24. Yang R, Laine L. Mucosal stripping: a complication of push enteroscopy . Gastrointest Endosc . 1995;4:156-158.Crossref 25. Richter J, Christensen M, Colditz G. Angiodysplasia: natural history and efficacy of therapeutic interventions . Dig Dis Sci . 1989;34:1542-1546.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Complete Intraoperative Small-Bowel Endoscopy in the Evaluation of Occult Gastrointestinal Bleeding Using the Sonde Enteroscope

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430150050010
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To review our experience with intraoperative small-bowel Sonde enteroscopy in evaluating occult bleeding in the small intestine. Design: Retrospective study with 100% follow-up. Setting: University-affiliated, tertiary-care teaching hospital. Patients: Sixteen consecutive patients referred with occult gastrointestinal bleeding in whom esophagogastroduodenoscopy, push enteroscopy, and colonoscopy had failed to identify the source of bleeding. Fourteen of the 16 patients had required one or more transfusions. Main Outcome Measures: 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 radiotion 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.(Arch Surg. 1996;131:272-277) References 1. Szold A, Katz LB, Lewis BS. Surgical approach to occult gastrointestinal bleeding . Am J Surg . 1992;163:90-93.Crossref 2. Lewis BS. Small intestinal bleeding . Gastroenterol Clin North Am . 1994;23:6791. 3. Dykman DD, Killian SE. Initial experience with the Pentax VSBOP2900 enteroscope . Am J Gastroenterol . 1993:88:570-573. 4. Berner JS, Mauer K, Lewis B. Push and Sonde enteroscopy for the diagnosis of obscure gastrointestinal bleeding . Am J Gastroenterol . 1994;89:2139-2142. 5. Foutch PG, Sawyer R, Sanowski R. Push-enteroscopy for diagnosis of patients with gastrointestinal bleeding of obscure origin . Gastrointest Endosc . 1990;36:337-341.Crossref 6. Lewis B, Waye J. Small bowel enteroscopy: a comparison of findings with push and Sonde enteroscopy in 81 patients with Gl bleeding of obscure origin . Gastrointest Endosc . 1988;34:207-211. 7. Messer J, Romeu J, Waye J, et al. The value of proximal jejunoscopy in unexplained gastrointestinal bleeding . Gastrointest Endosc . 1984;30:151. 8. Lewis BS, Waye JD. Chronic gastrointestinal bleeding of obscure origin: role of small bowel enteroscopy . Gastroenterology . 1988;94:1117-1120. 9. Bombeck CT. Intraoperative esophagoscopy, gastroscopy, colonoscopy, and endoscopy of the small bowel . Surg Clin North Am . 1975;55:135-142. 10. Apelgren K, Vargish T, Al-Kawas F. Principles for use of intraoperative enteroscopy for hemorrhage from the small bowel . Am Surg . 1988:54:85-87. 11. Bowden T. Endoscopy of the small intestine . Surg Clin North Am . 1989:19: 1237-1247. 12. Desa L, Ohri S, Hutton K, et al. Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel origin . Br J Surg . 1991;78: 192-195.Crossref 13. Flickinger E, Stanforth C, Sinar D, et al. Intraoperative video panendoscopy for diagnosing sites of chronic intestinal bleeding . Am J Surg . 1989;157:137-144.Crossref 14. Frank M, Brandt L, Boley S. latric submucosal hemorrhage: a pitfall of intraoperative endoscopy . Am J Gastroenterol . 1981;75:209-210. 15. Lau W, Wong S, Yuen W, et al. Intraoperative enteroscopy for bleeding angiodysplasias of the small intestine . Surg Gynecol Obstet . 1989;168:341-344. 16. Mathus-Vliegen E, Tytgat G. Intraoperative endoscopy: technique, indications and results . Gastrointest Endosc . 1986;32:381-384.Crossref 17. Strodel W, Eckhauser F, Knol J, et al. Intraoperative fiberoptic endoscopy . Am Surg . 1984;50:340-344. 18. Lewis B, Wenger J, Waye J. Intraoperative enteroscopy versus small bowel enteroscopy in patients with obscure GI bleeding . Am J Gastroenterol . 1995; 86:171-174. 19. Ress AM, Benacci JC, Sarr MG. Efficacy of intraoperative enteroscopy in diagnosis and prevention of recurrent, occult gastrointestinal bleeding . Am J Surg . 1992;163:94-99.Crossref 20. Lau WY, Yuen WK, Chu KW, Poon GP, Li AKC. Obscure bleeding in the gastrointestinal tract originating in the small intestine . Surg Gynecol Obstet . 1992: 174:119-124. 21. Hoffman JS, Cave DR, Birkett D. Intra-operative enteroscopy with a Sonde intestinal fiberscope . Gastrointest Endosc . 1994;40:229-230.Crossref 22. Gostout CJ. Improving the withdrawal phase of Sonde enteroscopy with the 'push-away' method . Gastrointest Endosc . 1993;39:69-72.Crossref 23. Chong J, Tagle M, Barkin JS, Reiner DK. Small bowel push-type fiberoptic enteroscopy for patients with occult gastrointestinal bleeding or suspected small bowel pathology . Am J Gastroenterol . 1994;89:2143-2146. 24. Yang R, Laine L. Mucosal stripping: a complication of push enteroscopy . Gastrointest Endosc . 1995;4:156-158.Crossref 25. Richter J, Christensen M, Colditz G. Angiodysplasia: natural history and efficacy of therapeutic interventions . Dig Dis Sci . 1989;34:1542-1546.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1996

References