Role of intraoperative enteroscopy in the management of obscure gastointestinal bleeding at the time of video-capsule endoscopy

Douard, Richard; Wind, Philippe; Berger, Anne; Maniere, Thibaut; Landi, Bruno; Cellier, Christophe; Cugnenc, Paul-Henri

doi:10.1016/j.amjsurg.2008.06.036

« Previous Next »The American Journal of Surgery
Volume 198, Issue 1 , Pages 6-11, July 2009

Role of intraoperative enteroscopy in the management of obscure gastointestinal bleeding at the time of video-capsule endoscopy

Richard Douard, M.D., Ph.D.
- Department of General and Digestive Surgery, AP-HP European, Georges Pompidou University Hospital, Paris, France
- Paris Descartes Faculty of Medicine, Paris, France
- Corresponding author. Tel.: +33-1-58-41-13-26; fax: +33-1-43-26-56-75
Philippe Wind, M.D.
- Department of General and Digestive Surgery, Avicenne AP-HP University Hospital, Bobigny, France
- Paris XIII University, Bobigny, France
Anne Berger, M.D.
- Department of General and Digestive Surgery, AP-HP European, Georges Pompidou University Hospital, Paris, France
- Paris Descartes Faculty of Medicine, Paris, France
Thibaut Maniere, M.D.
- Department of Endoscopy and Gastroenterology, AP-HP European, Georges Pompidou Hospital, Paris, France
- Paris Descartes Faculty of Medicine, Paris, France
Bruno Landi, M.D.
- Department of Endoscopy and Gastroenterology, AP-HP European, Georges Pompidou Hospital, Paris, France
- Paris Descartes Faculty of Medicine, Paris, France
Christophe Cellier, M.D., Ph.D.
- Department of Endoscopy and Gastroenterology, AP-HP European, Georges Pompidou Hospital, Paris, France
- Paris Descartes Faculty of Medicine, Paris, France
Paul-Henri Cugnenc, M.D.
- Department of General and Digestive Surgery, AP-HP European, Georges Pompidou University Hospital, Paris, France
- Paris Descartes Faculty of Medicine, Paris, France

Received 8 March 2008; received in revised form 6 June 2008 published online 27 April 2009.

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.

Keywords: Double-balloon enteroscopy, GI bleeding, obscure, Intraoperative enteroscopy, Video-capsule endoscopy