**Author details**

*Endoscopy in Small Bowel Diseases*

lesions such as angiodysplasia, etc.

**6. Limitations**

not possible [7].

**7. Conclusions**

**Conflict of interest**

The overall mortality rate of IOE from the combined data of 14 studies including 419 patients was 5% [37]. The main causes of death were multiorgan failure, septic

An important issue in patients with obscure GI bleed after any investigation or treatment is the development of recurrent GI bleed. The reported incidence of recurrent GI bleed ranges from 13–52% in different series [9, 36, 37]. It is important to note that differentiation between iatrogenic mucosal trauma from mucosal vascular lesions by IOE is difficult [39]. Secondly, vascular lesions can be evanescent, hence early IOE or at time of bleeding can make the detection of these lesions possible [40]. Other reasons for rebleeding could be appearance of new lesions due to same or different disease, incomplete endoscopic treatment of the existing

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

With the increasing use of DAE, the need for IOE has reduced. However, it continues to be an extremely useful tool in patients with obscure GI bleed, multiple polyposis syndromes, multiple foreign bodies or bowel obstruction where DAE cannot be performed or has failed. Moreover, IOE has been found to reduce the need for repeated surgeries by allowing complete small bowel examination and treatment in the same sitting. Although IOE via laparotomy remains the gold standard, availability of advanced minimally invasive equipments have allowed

IOE to be performed via multiport or single port laparoscopy.

The authors have no conflict of interest to declare.

shock, diffuse intravascular coagulopathy and hemorrhagic shock [37].

**102**

Rahul Gupta1 \*, Arvind K. Singh2 , Jyoti Gupta3 and Houssem Ammar4

1 Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India

2 Department of Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, India

3 Department of Radiation Oncology, Swami Rama Himalayan University, Dehradun, India

4 Department of Surgery, Sousse Hospital, Sousse, Tunisia

\*Address all correspondence to: rahul.g.85@gmail.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
