2005 Abstracts: Minimally Invasive Surgery As Treatment of Obscure GI Bleeding and Abdominal Complaints Can Be Effectively Guided by Video Capsule Endoscopy: A Review of 28 Patients
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Minimally Invasive Surgery As Treatment of Obscure GI Bleeding and Abdominal Complaints Can Be Effectively Guided by Video Capsule Endoscopy: A Review of 28 Patients
Janos Taller, Crystine M. Lee, John J. Feng, Paul T. Cirangle, Gregg H. Jossart, California Pacific Medical Center, San Francisco, CA
Background: Video capsule endoscopy (VCE) is increasingly being used to assess patients with obscure sources of GI blood loss and vague abdominal complaints. Operative intervention can be guided by results of VCE.
Methods: Patients were assessed for surgical intervention based on findings seen on VCE obtained for assessment of GI complaints. Patients were offered surgery if the diagnosis from VCE was felt to be amenable to surgical treatment. In the OR, patients underwent a diagnostic laparoscopy (DL) to rule out an extra-luminal source of their GI complaints. (An open exploration was performed if DL could not be completed secondary to post-operative adhesions). After exploration, a 4 cm peri-umbilical incision was made and the small bowel (SB) segmentally eviscerated. Through one (or more) enterotomies, an open small bowel push-enteroscopy (SBPE) was performed evaluating the SB from the ligament of Treitz through the ileocecal valve. Operative interventions appropriate for findings were then performed. Results: From SEP 2001 to OCT 2004, 28 patients, 9 men & 19 women, were evaluated for chronic GI complaints. Primary presenting diagnoses were: Chronic anemia/Heme (+) Stool: 39% (11/28), Melena: 36% (10/28), Hematochezia: 14% (4/28), Abdominal pain/Obstruction: 10% (3/28). These patients underwent VCE with the following findings: Arterio-venous Malformations (AVMs): 57%, (16/28), Stricture: 17% (5/28), Tumor: 7%, (2/28), Non-specific Bleeding: 10% (3/28), Normal: 7%, (2/28). Based on clinical history and VCE findings, 21 patients, 7 men & 14 women, were taken to surgery. 13 patients (61%) underwent DL and 8 patients (39%) underwent open exploration.2 patients had an obvious small bowel tumor seen on initial DL which was removed via laparoscopic SB resection. The remaining 19 patients underwent open SBPE.12 patients (57%) were confirmed to have AVMs: 10 patients had their AVMs oversewn and 2 patients required SB resection.5 patients (23%) were confirmed to have significant luminal strictures, each requiring SB resection.1 patient (4%) thought from VCE to have an AVM was diagnosed with a SB tumor which was resected.1 patient (4%) had a completely normal exploration. There were no peri-operative complications. Conclusion: Diagnostic video capsule endoscopy, in combination with operative exploration and enteroscopy, can effectively diagnose and guide surgical treatment in those patients with chronic obscure GI bleeding and complaints.
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