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Endoscopy II
PTU-219 Intraoperative endoscopy: the first single-centre UK experience
  1. K Evans,
  2. S Akula,
  3. I C Cameron,
  4. D S Sanders,
  5. M E McAlindon,
  6. R Sidhu
  1. Royal Hallamshire Hospital, Sheffield, UK

Abstract

Introduction Intra-operative enteroscopy (IOE) is the gold standard for examination of the small bowel. However, with the invention of capsule endoscopy (CE) and double balloon endoscopy (DBE), the role of IOE has been questioned. Our aim was identify the indications for IOE and associated morbidity and mortality. We also made comparisons between CE and IOE.

Methods All patients that underwent IOE between 2003 and 2011 were included. Data collected included demographics, clinical indications, co-morbidity, transfusion requirements, findings at IOE and subsequent follow-up.

Results There were 17 IOEs, 8 males, with a mean age of 57 years (range 34–93). The median follow-up period was 9 months (range 0–48 months). The indication was iron deficiency anaemia (IDA) in all patients (occult bleeding (n=10) and overt bleeding (n=7)). Ten patients were transfusion dependent. The median haemoglobin pre-IOE was 7.7 g/dl (SD 1.4). 71% (n=12) had significant co-morbidity which included ischaemic heart disease, diabetes and bronchiectasis. Small bowel investigations prior to IOE included DBE (n=9) and CE (n=16). Two patients had therapeutic intervention at DBE, both argon plasma coagulation (APC) to angiodysplasia. In seven patients the abnormality on CE was not reached at DBE. The diagnostic yield for IOE was 88% (15/17). In two patients, the IOE was normal. Findings at IOE included Meckels diverticulum (n=2), arteriovenous malformations (n=7), small bowel tumours (n=3; benign glomus tumour, leiomyoma and carcinoid), bleeding point at surgical anastamosis (n=2; post hepatectomy and at a transplanted pancreatic bed) and small bowel ulceration secondary to NSAIDs and nicorandil. Intervention at IOE occurred in 82% (n=14). These included 10 small bowel resections, two APC, one revision of anastamosis, one oversewing of angiomata. While the morbidity rate was 18% (n=3) with two post-operative bleeds requiring transfusion and a seizure secondary to hyponatraemia, there were no deaths within 30 days. Evidence of recurrent GI bleeding occurred in four patients all of whom have lower transfusion requirements than before, 1 being on tranexamic acid, and 1 on somatostatin analogue. In the two patients with a normal IOE; the patient with IDA remains well 6 months post IOE while the second patient with diarrhoea and pain remains symptomatic without a diagnosis. A comparison of CE against IOE as the gold standard provided CE with a sensitivity, specificity, positive predictive and negative predictive values of 87%, 100%, 100% and 33% respectively.

Conclusion IOE has a high diagnostic yield (88%) with a significant proportion having intervention at IOE. There remains an important role for IOE in a select group of patients with transfusion –dependent anaemia.

Competing interests None declared.

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