The Use of Intraoperative Enteroscopy in Neonatal Surgery

Objective: To evaluate Intra Operative Enteroscopy (IOE) as a valuable expositive adjunct in neonatal small bowel surgery to assess intraluminal pathologies and anastomoses. We used direct visualization using IOE in place of intra-operative dye studies.

Background Data: Evaluation of neonatal small bowel is difficult and treacherous, especially in cases of necrotizing enterocolitis (NEC), atresias, meconium ileus, and occult pathologies. Blind, rather ineffective methods (such as plain abdominal radiograph and barium enema) have been used for decades to evaluate small bowel pathology in neonatal surgery. However, the installation of saline via rubber tubing inserted through an enterotomy is an essentially blind procedure that garnes very limited clinical information.

Methods: Five neonatal cases were reviewed in which IOE was substituted for previously described blind techniques to evaluate strictures, atresia, and a previously formed anastomosis. We utilized a pediatric gastroenterology team to perform the intraoperative endoscopy.

Results: IOE was able discern intraluminal pathologies and anastomosis in all five neonates, resulting in fewer and safer surgeries. There were no complications.

Conclusions: IOE, with today`s miniaturized endoscopes, is a technique that provides direct visualization of the small bowel lumen and could replace older, blind techniques as a method to discern intraluminal pathologies and/or evaluate anastomoses in neonatal surgery.