Capsule endoscopy versus intraoperative enteroscopy in management of small bowel arteriovenous malformations

Background Small bowel arteriovenous malformations (AVMs) are the most common cause of obscure gastrointestinal bleeding, and they are problematic cases both in diagnosis and treatment. Patients and methods A total of 12 patients with small bowel AVMs admitted to Zagazig University hospitals were included in this study. Cases with previous bleeding (group I) and cases with moderate ongoing bleeding (group II) underwent both capsule endoscopy (CE) and intraoperative enteroscopy (10E), whereas cases with massive ongoing bleeding (group 111) underwent IOE only. Results CE picked up the diagnosis of AVMs only in 50% of cases. It underestimated the extent of the lesions in 40% of positive cases and wrongly localized the lesion in 20% of positive cases. IOE diagnosed all 12 cases of AVMs. Two cases were treated with plasma photocoagulation and 10 cases were treated with resection of the diseased segment. There was only one perioperative mortality. Conclusion CE has a limited diagnostic yield in cases of small bowel AVMs especially in absence of ongoing bleeding, and 10E remains the mainstay method for diagnosis and treatment of these cases.