Intra-operative endoscopy. University of Minnesota experience

This review of intraoperative endoscopies was undertaken to identify the accepted and the controversial indications, to report the results and complications, and to determine the impact the procedure had on the operation performed. This retrospective review identified 78 patients who had undergone 82 intraoperative endoscopic exams between 1981 and 1987. Sixty-nine patients underwent intraoperative colonoscopy (84%), six had upper enteroscopy (7%), and seven had total gut endoscopy (9%). Indications were as follows: the inability to fully colonoscope preoperatively (29%), Crohn's disease (19%), malignant polypectomy site (12%), gastrointestinal bleeding (12%), routine screening to rule out synchronous lesions (12%), non palpable colonic lesions (11%), and miscellaneous (4%). Intraoperative endoscopy was successful in 89 per cent of patients. The exams provided information that altered the planned operation in 27 per cent of cases. There were four complications that may have been related to the endoscopic exams. All resolved without the need for further surgery. It is concluded that intraoperative endoscopy can greatly influence the operation performed in a significant percentage of cases. The clear cut indications for its use at this time are location of malignant polypectomy sites, adhesions or tortuous colon that prevents complete preoperative colonoscopy, chronic gastrointestinal bleeding, and location of non palpable bowel lesions. Controversial indications that we feel will prove useful include Crohn's disease and acute gastrointestinal bleeding. Intraoperative endoscopy is best used as an adjunct to preoperative endoscopy and not as a substitute for it.