Laparotomy and intraoperative enteroscopy for obscure gastrointestinal bleeding before and after the era of video capsule endoscopy and deep enteroscopy: A tertiary center experience - 20/03/18

Doi : 10.1016/j.amjsurg.2017.05.018

Wuttiporn Manatsathit ^a,^b, Usah Khrucharoen ^b,^c,^d, Dennis M. Jensen ^b,^c,^d,^⁎ , O. Joe Hines ^b,^c,^e, Thomas Kovacs ^b,^c,^d, Gordon Ohning ^b,^c,^d, Rome Jutabha ^b,^c, Kevin Ghassemi ^b,^c, Gareth S. Dulai ^b,^c,^d, Gustavo Machicado ^b,^c,^d
^a Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, United States
^b CURE Digestive Diseases Research Center (DDRC) - GI Hemostasis Unit, Los Angeles, CA, United States
^c David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
^d VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
^e Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States

^∗Corresponding author. CURE Digestive Diseases Research Center, Bldg 115 Rm 318, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073-1003, United States.CURE Digestive Diseases Research CenterVA Greater Los Angeles Healthcare SystemBldg 115 Rm 31811301 Wilshire Blvd.Los AngelesCA90073-1003United 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.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Obscure gastrointestinal bleeding, Deep enteroscopy, Video capsule endoscopy, Intraoperative enteroscopy, Exploratory laparotomy

Mappa

Introduction

Material and methods

Preoperative diagnoses

Operative and IOE diagnoses

Follow-up and rebleeding

Data and statistical analyses

Results

Preoperative and IOE diagnoses

Definitive diagnoses

Rebleeding rate

Morbidity and mortality

Discussion

Conclusions

Funding

Esportazione

Vol 215 - N° 4

P. 603-609 - aprile 2018 Ritorno al numero

Articolo precedente

Preoperative predictor of extensive resection for acute appendicitis
Fumitaka Saida, Shokei Matsumoto, Mitsuhide Kitano

| Articolo seguente

Delineating the burden of chronic post-operative pain in patients undergoing open repair of complex ventral hernias
Colin G. DeLong, Justin A. Doble, Amber L. Schilling, Eric M. Pauli, David I. Soybel

Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.

Già abbonato a @@106933@@ rivista ?

connettersi o creare un account

Laparotomy and intraoperative enteroscopy for obscure gastrointestinal bleeding before and after the era of video capsule endoscopy and deep enteroscopy: A tertiary center experience - 20/03/18

Abstract

Background

Methods

Results

Conclusions

Mappa

Citazioni Export

File

Contenuto

Il mio account

Aide & support

Dichiarazione CNIL