**3.1 Intraoperative endoscopy via oral route**


#### **Figure 7.**

*Schematic presentation of different routes for intraoperative enteroscopy: (A) Transoral route, (B) transanal route and (C) enteroscopy via enterotomy.*


**99**

*Role of Intraoperative Endoscopy in the Management of Small Bowel Diseases*

• After completion of the endoscopy, the lesions at the marked sites are excised surgically by multiple enterotomies or segmental bowel resection depending

• This is the least preferred route for IOE due to limited maneuverability.

• The steps are similar to that of colonoscopy (**Figure 7B**). In case of difficulty in negotiating the scope across the colonic flexures, the operating surgeons can

• Small lesions can be excised or biopsied endoscopically while large lesions can

• After reaching the ileocecal region, the surgeon slowly pushes the ileal loops over the scope for the mucosal examination. However, evaluation of the small

• In such cases, if there is a large colonic lesion requiring surgical excision, a colotomy can be made near the site of resection and the colonoscope can be

• A circular purse-string suture is taken at a suitable point (usually the mid portion) of the small intestine on the anti-mesenteric side [6]. A small enterotomy is made at the center of the purse string suture just sufficient enough to

• The endoscope is inserted through the enterotomy and the circular suture is tied around the scope over the bowel to prevent air leak during insufflation

• First, the proximal part of the small intestine is examined due to lower

scope and minimum insufflation to prevent bowel injury.

by the operating surgeon with a simple suture.

clamped and vice-versa to prevent over-inflation.

• Enteroscopy should be performed slowly with gradual advancement of the

• Endoscopic biopsy or excision is performed for the visualized mucosa lesions as appropriate. If surgical excision is required, then the site of lesion is marked

• During the inspection of the proximal half of the small bowel, the distal part if

• The endoscopic views during IOE are different from the routine endoscopic picture due to transillumination by the operating lights in the theater. However, the operating lights can be dimmed if required as per the endoscopist's choice.

advanced through it to facilitate further small bowel examination.

• After appropriate adhesiolysis, whole of the small bowel is freed.

• The procedure can be performed in lithotomy or left lateral position.

be marked with simple suture for subsequent surgical excision.

bowel beyond terminal ileum via anal route is difficult.

*DOI: http://dx.doi.org/10.5772/intechopen.95851*

upon the intraoperative findings.

**3.2 IOE via anal route**

guide the scope.

**3.3 IOE via enterotomy**

(**Figure 7C**).

bacterial load.

allow the passage of the endoscope.

*Role of Intraoperative Endoscopy in the Management of Small Bowel Diseases DOI: http://dx.doi.org/10.5772/intechopen.95851*

• After completion of the endoscopy, the lesions at the marked sites are excised surgically by multiple enterotomies or segmental bowel resection depending upon the intraoperative findings.
