Journal Basic Info

  • Impact Factor: 1.989**
  • H-Index: 6
  • ISSN: 2637-4625
  • DOI: 10.25107/2637-4625
**Impact Factor calculated based on Google Scholar Citations. Please contact us for any more details.

Major Scope

  •  Transplant Surgery
  •  Spine Surgery
  •  Bariatric Surgery
  •  Ophthalmology & Eye Surgery
  •  Vascular Surgery
  •  Pediatric Surgery
  •  Cardiovascular Surgery
  •  Neurological Surgery

Abstract

Citation: World J Surg Surg Res. 2019;2(1):1179.DOI: 10.25107/2637-4625.1179

Intraoperative Enteroscopy: A Fast and Safe Technique for Localization and Treatment of Small Bowel Lesions

Amanda Fazzalari1,2, Shruthi Srinivas1, Natalie Pozzi2, Christopher Schlieve1, Jonathan Green MSCI1, Demetrius Litwin1, David Cave3 and Mitchell A Cahan1*

1Department of Surgery, University of Massachusetts Medical School, USA
2Department of Surgery, Saint Mary’s Hospital, USA
3Department of Gastroenterology, University of Massachusetts Medical School, USA

*Correspondance to: Mitchell A Cahan 

 PDF  Full Text Research Article | Open Access

Abstract:

Objective: Intraoperative Enteroscopy (IOE) was first described in the late 1960s and is regarded
as the gold standard for complete evaluation of the small bowel. However, with the advent of deep
endoscopy and video capsule endoscopy, IOE has been used less frequently. Recently we published
a large series demonstrating that IOE is a valuable tool for the final diagnosis and treatment of Small
Intestinal Bleeding (SIB) and non-adhesive Obstructive Small Bowel Disease (OSBD) [1]. Existing
literature lacks clear guidelines on the technique of IOE; therefore, we propose safe and effective
methods to guide the surgeon’s approach to IOE.
Methods and Procedures: As we recently described IOE is indicated in patients with SIB that
is visualized but cannot be treated via endoscopy. For OSBD, IOE is indicated when computed
tomography and/or initial enteroscopy are non-diagnostic and there is a suspicion for a resectable
lesion (i.e. tumor or diverticulum), or when a pathologic lesion is identified but not amenable to
endoscopic therapy. The procedure begins with standard diagnostic laparoscopy and complete
evaluation of the small bowel. The evaluation includes visualizing a lesion or tattoos which may have
been marked endoscopically beforehand. If no small bowel lesion is visualized, a six-centimeter
supra-umbilical incision is made and an Alexis® wound protector is inserted for the purpose of IOE.
The small bowel is eviscerated for complete visual inspection and manual palpation. If no lesion is
palpated, IOE follows via an enterotomy made in proximity to the anticipated lesion or between
proximally and distally marked ink tattoos. The enteroscope is secured with a purse string suture
to prevent leakage of enteric contents. The small bowel mucosa is examined both anterograde and
anterograde, with the gastroenterologist controlling the enteroscope and the surgeon simultaneously
advancing the scope and telescoping the bowel extracorporally over it. Carbon dioxide is ideally
used for insufflation. Definitive treatment depends on the type of lesion identified, with small
bowel resection being the most common procedure. Post-operative management is patient and
provider dependent. Generally, nasogastric tubes and urinary indwelling catheters are removed on
postoperative day one and diet advanced as tolerated.
Conclusion: IOE is a safe, fast, and effective method for diagnosing and treating SIB and OSBD
undiagnosed by conventional modalities. While the majority of the reports describing IOE have
been published in Europe or Asia, we have proven that this technique is accurate and valuable
in North America. Here we provide clear guidelines regarding the indications and appropriate
technique by which to perform IOE in the United States.

Keywords:

Cite the Article:

Fazzalari A, Srinivas S, Pozzi N, Schlieve C, Jonathan Green MSCI, Litwin D, et al. Intraoperative Enteroscopy: A Fast and Safe
Technique for Localization and Treatment of Small Bowel Lesions. World J Surg Surgical Res. 2019; 2: 1179..

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