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Intraoperative enteroscopy in Crohn's disease
K Smedh1, G Olaison, P O Nyström
1Department of Medico-Surgical Gastroenterology, University Hospital, Linköping, Sweden.
Abstract:
Intraoperative small bowel endoscopy was performed on 33 occasions in 31 patients with Crohn's disease. The extent of mucosal inflammation was compared with that of changes in the external bowel wall: serositis, fat-wrapping and mural thickening. The influence of endoscopic findings on surgical management was evaluated. Mucosal inflammation was generally more extensive than serositis (P < 0.01), but less so than mural thickening (P < 0.001). The extent of fat-wrapping did not differ from that of mucositis. Of 23 patients undergoing reoperation or with fistula or abscess, however, eight had serositis and/or fat-wrapping in bowel segments without mucosal inflammation. Endoscopic findings influenced surgical decisions on 20 of the 33 occasions, limiting planned resection in 14, identifying strictures for repair in one, and deciding against resection in two cases and for extended resection in three. These results suggest that external inflammatory changes are unreliable guides to the extent of intestinal mucositis and requirements for resection in Crohn's disease. By visualizing the mucosa, intraoperative enteroscopy can provide information for more precise surgery, thereby limiting resection.
Insights
Intraoperative enteroscopy in Crohn's disease revealed mucosal inflammation often differs from external bowel changes. This endoscopic visualization aids surgeons in making more precise decisions, potentially limiting unnecessary bowel resection.
Area of Science:
- Gastroenterology
- Surgical Endoscopy
- Inflammatory Bowel Disease
Background:
- Crohn's disease management often involves surgical resection.
- Assessing the extent of inflammation is crucial for surgical decision-making.
- External serosal changes are sometimes used as indicators of underlying mucosal disease.
Purpose of the Study:
- To compare the extent of mucosal inflammation with external bowel wall changes during surgery for Crohn's disease.
- To evaluate the impact of intraoperative endoscopic findings on surgical management decisions.
- To determine if external inflammatory signs reliably predict the need for resection.
Main Methods:
- Intraoperative small bowel endoscopy was performed in 33 instances across 31 patients with Crohn's disease.
- The extent of mucosal inflammation was correlated with external changes like serositis, fat-wrapping, and mural thickening.
- The influence of endoscopic findings on surgical decisions was documented.
Main Results:
- Mucosal inflammation was generally more extensive than serositis but less than mural thickening.
- Fat-wrapping extent was comparable to mucositis.
- In 8 of 23 reoperation/fistula/abscess cases, external changes were present without mucosal inflammation.
- Endoscopic findings altered surgical plans in 20 of 33 procedures, often limiting resection.
Conclusions:
- External inflammatory changes in Crohn's disease are unreliable indicators of mucosal disease extent and resection needs.
- Intraoperative enteroscopy provides direct visualization of the mucosa.
- This visualization enables more precise surgical decisions, potentially reducing the extent of resection.