**Abstract**

With the advances in the endoscopic technology, most of the small bowel diseases are being diagnosed by capsule endoscopy and device assisted enteroscopy. However, there are many clinical situations such as small bowel obstruction, foreign body impaction were these advanced endoscopic procedures cannot be performed. In such cases, intraoperative endoscopy plays a vital role in the management of these small bowel diseases. Intraoperative endoscopy is also very useful in identification of the site of obscure gastrointestinal bleeding in difficult cases. Moreover, capsule endoscopy and device assisted enteroscopy are expensive procedures and not readily available at all medical centers especially in low income countries. On the other hand, intraoperative endoscopy can be easily performed by conventional gastroscope and colonoscope. In this chapter, we have discussed the indications, techniques, outcomes and complications of intraoperative endoscopy in the current era of deep enteroscopy.

**Keywords:** intraoperative endoscopy, enteroscopy, inflammatory bowel disease, Peutz-Jeghers syndrome, Crohn's disease

### **1. Introduction**

Traditionally, intraoperative endoscopy (IOE) was the only means for the visualization of small bowel mucosal lesions not accessible to upper gastrointestinal endoscopy and colonoscopy. However, with the advances in abdominal imaging and the advent of capsule endoscopy (CE), the use of IOE diminished. A comparative study of CE and IOE found the sensitivity and specificity of CE to be 95% and 75%, respectively [1]. Hence, most guidelines recommend CE for detection of suspected small bowel lesions in patients with obscure gastrointestinal (GI) bleed. However, the main disadvantage of CE was inability to perform therapeutic procedures. Subsequently, the device assisted enteroscopy (DAE), namely, spiral endoscopy, double balloon enteroscopy (DBE) and single balloon enteroscopy (SBE) was developed which has brought paradigm shift in the treatment of small bowel mucosal diseases. DAE allows visualization, biopsy and removal of the small bowel mucosal lesions.

However, IOE is still an indispensable tool for the evaluation and treatment of small bowel diseases in special situations and institutions with lack of DAE


**Table 1.**

*Advantages and disadvantages of intraoperative endoscopy.*

facilities. The reported success rate of IOE to achieve complete enteroscopy ranges between 57–100% in different series [1–10]. The advantages and disadvantages of IOE have been summarized in **Table 1**.
