Wuttiporn Manatsathit1, Usah Khrucharoen2, Dennis M Jensen3, O Joe Hines4, Thomas Kovacs2, Gordon Ohning2, Rome Jutabha5, Kevin Ghassemi5, Gareth S Dulai2, Gustavo Machicado2. 1. Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, United States; CURE Digestive Diseases Research Center (DDRC) - GI Hemostasis Unit, Los Angeles, CA, United States. 2. CURE Digestive Diseases Research Center (DDRC) - GI Hemostasis Unit, Los Angeles, CA, United States; David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States. 3. CURE Digestive Diseases Research Center (DDRC) - GI Hemostasis Unit, Los Angeles, CA, United States; David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States. Electronic address: djensen@mednet.ucla.edu. 4. CURE Digestive Diseases Research Center (DDRC) - GI Hemostasis Unit, Los Angeles, CA, United States; David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States. 5. CURE Digestive Diseases Research Center (DDRC) - GI Hemostasis Unit, Los Angeles, CA, United States; David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
Abstract
BACKGROUND: To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). METHODS: We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. RESULTS: 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36.4% (4/11) had preoperative presumptive diagnoses while in the post VCE/DE era presumptive diagnoses were made in 48.8% (20/41) (p = 0.18). Preoperative evaluation led to correct diagnoses in 18.2% (2/11) in the pre and 51.2% (21/41) in the post VCE/DE era (p = 0.09). Vascular lesions and ulcers were the most common diagnoses, but rebleeding was common. No rebleeding was found among patients with tumors, Meckel's diverticulum, and aortoenteric fistula. CONCLUSIONS: Presumptive diagnoses in the post VCE/DE era were usually accurate. If VCE or DE are negative, the probability of negative IOE is high. Patients with tumors and Meckel's diverticulum were the best candidates for IOE.
BACKGROUND: To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). METHODS: We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. RESULTS: 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36.4% (4/11) had preoperative presumptive diagnoses while in the post VCE/DE era presumptive diagnoses were made in 48.8% (20/41) (p = 0.18). Preoperative evaluation led to correct diagnoses in 18.2% (2/11) in the pre and 51.2% (21/41) in the post VCE/DE era (p = 0.09). Vascular lesions and ulcers were the most common diagnoses, but rebleeding was common. No rebleeding was found among patients with tumors, Meckel's diverticulum, and aortoenteric fistula. CONCLUSIONS: Presumptive diagnoses in the post VCE/DE era were usually accurate. If VCE or DE are negative, the probability of negative IOE is high. Patients with tumors and Meckel's diverticulum were the best candidates for IOE.
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