Is Intraoperative Endoscopy the Safest Approach for Gastrointestinal Bleeding?

Male Surgeon and Surgical Assistant in operating room of hospital performing Endoscopy procedure on patient, colonoscopy, crc, polyp
In a retrospective analysis, researchers compared the different ways to perform an intraoperative endoscopy for overt obscure gastrointestinal bleeding.

Intraoperative endoscopy (IOE) via trans-enterotomy provided the safest method of managing overt obscure gastrointestinal bleeding (OGIB) with less postoperative adverse outcomes compared with oral, anal, or combination routes of IOE, according to study findings published in the International Journal of Surgery Open.

Patients with overt OGIB will often require IOE to help manage their gastrointestinal bleeding. However, IOE is associated with a high risk for morbidity and mortality. The objective of the current study was to identify a safer approach for performing IOE in patients with overt OGIB that cannot be managed by nonoperative strategies.

Researchers conducted a retrospective analysis of 98 patients with overt OGIB who underwent IOE between October 2014 and November 2020 at the Affiliated Zhongda Hospital in China. They divided the patients into 3 groups according to the type of IOE performed with 31 in the IOE-enterotomy group, 26 in the IOE-oral group, 23 in the IOE-anal group, and 18 in the IOE-combination group.

IOE via enterotomy took less time to perform than the other 3 methods of IOE (P <.05), resulted in decreased length of hospital stays compared with the IOE-anal (P =.025) and IOE-combination groups (P =.017), and trended toward decreased length of stay compared with the IOE-oral group (P =.093).

Compared with the IOE-anal and IOE-combination routes, patients who underwent enterotomy experienced less postoperative morbidities such as postoperative ileus, mucosal lacerations, mesenteric lacerations, small-bowel adhesive obstruction, temporary azotemia, anastomotic leakage, and infections of the incision, chest, or urinary tract (P =.028 and P =.002, respectively). No patient died due to postoperative complications during the study.

Researchers obtained long-term follow-up information for 72 of the 98 patients — 23 in the IOE-enterotomy group, 21 in the IOE-oral group, 15 in the IOE-anal group, and 13 in the IOE-combination group. Following IOE, rebleeding occurred in 1 of 23 (4.3%) patients in the enterotomy group, 2 of 21 (9.5%) patients in the IOE-oral group, and 3 of the 13 (23%) patients in the IOE-combination group, while no patient in the IOE-anal group experienced rebleeding.

“Intraoperative endoscopy through enterotomy represents a safer and more ideal strategy in the management of overt OGIB,” the researchers concluded. “It offers the advantages of the precise location of the bleeding source, less operative time, and minimal surgical morbidity.”

Reference

Tao Q, AL-Magedi AAS, Wang Z, Xu W, Wu R. Intraoperative endoscopy through enterotomy for overt obscure gastrointestinal bleeding: A retrospective cohort study. Int J Surg Open. 2022;42:100465. doi:10.1016/j.ijso.2022.100465