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. 1993 May;34(5):647–649. doi: 10.1136/gut.34.5.647

Perioperative endoscopy of the whole small bowel in Crohn's disease.

D Lescut 1, D Vanco 1, P Bonnière 1, M Lecomte-Houcke 1, P Quandalle 1, A Wurtz 1, J F Colombel 1, J S Delmotte 1, J C Paris 1, A Cortot 1
PMCID: PMC1374183  PMID: 8504965

Abstract

The aim of this study was to search for small bowel lesions by means of a perioperative endoscopy in 20 patients operated on for Crohn's disease. Seven women and 13 men (mean age 29 years) had a total retrograde exploration to the angle of Treitz during an ileocolectomy (16 of 20 patients) or a colonic or ileal resection (four of 20 patients). Endoscopic exploration was completed, through an enterotomy, from the surgical area to the angle of Treitz. Periendoscopic biopsy samples were taken on macroscopic lesions and every 20 cm systematically. In 13 of 20 cases, various lesions scattered over the whole small intestine were found. These were aphthoid ulcerations (10 patients), superficial ulcerations (seven patients), mucosal oedema (three patients), non-ulcerative stenosis (three patients), erythema (two patients), pseudopolyps (two patients), deep ulcerations (two patients), and ulcerative stenosis (one patient). In seven patients none of the lesions detected at perioperative endoscopy had been recognised by preoperative evaluation or surgical inspection of the serosal surface. A typical granuloma was found at biopsy of lesions identified by endoscopy in three cases and at biopsy of an apparently healthy area in one case. Thus 65% of patients operated on for Crohn's disease had lesions of the small intestine detected by endoscopy, which were unrecognised before surgery in more than half of the cases.

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Selected References

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  1. Alexander-Williams J., Allan A., Morel P., Hawker P. C., Dykes P. W., O'Connor H. The therapeutic dilatation of enteric strictures due to Crohn's disease. Ann R Coll Surg Engl. 1986 Mar;68(2):95–97. [PMC free article] [PubMed] [Google Scholar]
  2. Alexander-Williams J., Haynes I. G. Conservative operations for Crohn's disease of the small bowel. World J Surg. 1985 Dec;9(6):945–951. doi: 10.1007/BF01655400. [DOI] [PubMed] [Google Scholar]
  3. Cooper J. C., Williams N. S. The influence of microscopic disease at the margin of resection on recurrence rates in Crohn's disease. Ann R Coll Surg Engl. 1986 Jan;68(1):23–26. [PMC free article] [PubMed] [Google Scholar]
  4. Hamilton S. R., Reese J., Pennington L., Boitnott J. K., Bayless T. M., Cameron J. L. The role of resection margin frozen section in the surgical management of Crohn's disease. Surg Gynecol Obstet. 1985 Jan;160(1):57–62. [PubMed] [Google Scholar]
  5. Heuman R., Boeryd B., Bolin T., Sjödahl R. The influence of disease at the margin of resection on the outcome of Crohn's disease. Br J Surg. 1983 Sep;70(9):519–521. doi: 10.1002/bjs.1800700904. [DOI] [PubMed] [Google Scholar]
  6. Hällgren R., Colombel J. F., Dahl R., Fredens K., Kruse A., Jacobsen N. O., Venge P., Rambaud J. C. Neutrophil and eosinophil involvement of the small bowel in patients with celiac disease and Crohn's disease: studies on the secretion rate and immunohistochemical localization of granulocyte granule constituents. Am J Med. 1989 Jan;86(1):56–64. doi: 10.1016/0002-9343(89)90230-1. [DOI] [PubMed] [Google Scholar]
  7. Mary J. Y., Modigliani R. Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicentre study. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut. 1989 Jul;30(7):983–989. doi: 10.1136/gut.30.7.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Nakatake K. [Operative intestinal fiberscopic findings and recurrences following surgery in Crohn's disease]. Fukuoka Igaku Zasshi. 1984 Jun;75(6):366–379. [PubMed] [Google Scholar]
  9. Olaison G., Smedh K., Sjödahl R. Natural course of Crohn's disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992 Mar;33(3):331–335. doi: 10.1136/gut.33.3.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Pennington L., Hamilton S. R., Bayless T. M., Cameron J. L. Surgical management of Crohn's disease. Influence of disease at margin of resection. Ann Surg. 1980 Sep;192(3):311–318. doi: 10.1097/00000658-198009000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Rutgeerts P., Geboes K., Vantrappen G., Kerremans R., Coenegrachts J. L., Coremans G. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut. 1984 Jun;25(6):665–672. doi: 10.1136/gut.25.6.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Tytgat G. N., Mulder C. J., Brummelkamp W. H. Endoscopic lesions in Crohn's disease early after ileocecal resection. Endoscopy. 1988 Sep;20(5):260–262. doi: 10.1055/s-2007-1018188. [DOI] [PubMed] [Google Scholar]
  13. Willoughby C. P., Piris J., Truelove S. C. Tissue eosinophils in ulcerative colitis. Scand J Gastroenterol. 1979;14(4):395–399. [PubMed] [Google Scholar]
  14. Wolff B. G., Beart R. W., Jr, Frydenberg H. B., Weiland L. H., Agrez M. V., Ilstrup D. M. The importance of disease-free margins in resections for Crohn's disease. Dis Colon Rectum. 1983 Apr;26(4):239–243. doi: 10.1007/BF02562486. [DOI] [PubMed] [Google Scholar]

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