**6. Limitations**

IOE involves lot of small bowel handling and manipulation to allow smooth passage of the endoscopy across the bowel loops. In cases of dense adhesions with shortened mesentery, IOE can be difficult and increase the risk of bowel injury. Another situation where IOE is difficult is in the presence of massive GI bleeding as the lumen is completely filled with blood and examination of the bowel mucosa is not possible [7].
