Intraoperative enteroscopy in Crohn's disease

✍ Scribed by K. Smedh; Dr. G. Olaison; P.-O. Nyström; R. Sjödahl

• Publisher: John Wiley and Sons
• Year: 1993
• Tongue: English
• Weight: 462 KB
• Volume: 80
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800800732

✦ Synopsis

Intraoperative smull bobtvel endoscopy was performed on 33 occasions in 31 patients with Crohn's disease. The extent of mucosal injlammation IVUS compared with that of changes in the external bowel wall: serositis, fat-wrapping and mural thickening. The influence of endoscopic findings on surgical management M?US evuluated. Mucosul inflammation was generally more extensive than serositis ( P < O.Ol), but less so than mural thickening ( P < 0.001). The extent of fat-wrapping did not difler from that of tnucositis. Of 23 patients undergoing reoperation or with fistula or ubsccss, however, eight had serositis andlor fat-wrapping in bowel segments without mucosal inflammation. Endoscopic $findings injuenced surgical decisions on 20 o f t h e 33 occasions, limiting planned resection in 14, identqyiny strictures f o r repair in one, and deciding against reJection 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 injormation j o r more precise surgery, thereby limiting Dr G . Olaison resection.

Surgery remains important in the management of Crohn's disease, although most surgeons agree t h a t as m u c h bowel a s possible should be preserved a n d t h a t only grossly affected areas should be resected'.'. Conservative operations such as strictureplasty have been recommended for extensive Crohn's disease of the small boweI3s4. T h e surgical strategy is governed primarily by information obtained from radiological investigation, preoperative endoscopy and peroperative inspection of the bowel a n d resection margins.