Intraoperative enteroscopy for diagnosis and management of unexplained gastrointestinal bleeding

Background: The aim of this study was to evaluate the diagnostic and therapeutic yield of intraoperative enteroscopy in patients with obscure gastrointestinal (GI) bleeding. Methods: Complete intraoperative enteroscopy was performed in 25 patients with GI bleeding (overt hemorrhage 21, occult blood loss 4). The cause of GI bleeding was unknown before intraoperative enteroscopy in 20 patients and presumed in 5 (colon 4, duodenum 1). Results: Complete inspection of the small bowel was achieved in all cases. Mucosal-based lesions of the small bowel were identified in 16 of the 20 patients in whom the source of bleeding was unknown preoperatively (angiodysplasia 12, other causes 4). These lesions were treated by segmental small bowel resection (15) or medical therapy (1). With a mean 19-month follow-up, the rebleeding rate was 30% (6 of 20), and 2 of them in whom enteroscopy was negative died of massive hemorrhage. Intraoperative enteroscopy was normal in the 5 patients with bleeding of presumed GI origin preoperatively. Conclusions: Intraoperative enteroscopy remains a valuable tool for exploring obscure GI bleeding in selected patients.