Skip to main content
Top
Published in: Surgical Endoscopy 7/2007

01-07-2007 | Technique

Role of intraoperative enteroscopy for surgical decision making with Crohn’s disease

Authors: M. Hotokezaka, S-I. Jimi, H. Hidaka, N. Maehara, T-A. Eto, K. Chijiiwa

Published in: Surgical Endoscopy | Issue 7/2007

Login to get access

Abstract

Background

This study aimed to assess the role of intraoperative enteroscopy (IOE) in determining surgical treatment.

Methods

The IOE procedure was performed for 30 patients with Crohn’s disease. The degree of stricture and the presence of active ulcer were examined. Preoperative diagnoses and intraoperative findings obtained by inspection and palpation were noted and compared with the IOE findings.

Results

Of the 78 intestinal strictures observed by IOE (42%), 33 were not found by preoperative examination. Of the 45 strictures confirmed by IOE to be severe (<15 mm in diameter), 8 were judged to be mild (15–25 mm in diameter) or were not even identified by intraoperative inspection and palpation. Active ulcer was found at 12 of 33 mild strictures, and all 12 strictures were surgically corrected. Of 11 severe strictures detected by IOE at previous surgical sites, 9 were found preoperatively, and 4 were judged to be mild on the basis of inspection and palpation. Stricture was found at the ileocecal valve by IOE in seven patients, but was not diagnosed preoperatively in two of these patients.

Conclusion

Intraoperative enteroscopy provides useful information regarding the status of the lumen in patients with Crohn’s disease.
Literature
1.
go back to reference Alexander-Williams J (1993) Strictureplasty. In: Kumar D, Alexander-Williams J, Allan RN (eds) Crohn’s disease and ulcerative colitis: surgical management. Springer Verlag, London pp 89–101 Alexander-Williams J (1993) Strictureplasty. In: Kumar D, Alexander-Williams J, Allan RN (eds) Crohn’s disease and ulcerative colitis: surgical management. Springer Verlag, London pp 89–101
2.
go back to reference Alexander-Williams J, Haynes IG (1985) Conservative operations for Crohn’s disease of the small bowel. World J Surg 9: 945–951PubMedCrossRef Alexander-Williams J, Haynes IG (1985) Conservative operations for Crohn’s disease of the small bowel. World J Surg 9: 945–951PubMedCrossRef
3.
go back to reference Andrews HA, Allan RN (1990) Crohn’s disease of the small intestine. In: Allan RN, Keighley MRB, Alexander-Williams J, Hawkins C (eds) Inflammatory bowel diseases. Churchill Livingstone, London pp 459–472 Andrews HA, Allan RN (1990) Crohn’s disease of the small intestine. In: Allan RN, Keighley MRB, Alexander-Williams J, Hawkins C (eds) Inflammatory bowel diseases. Churchill Livingstone, London pp 459–472
4.
go back to reference Arima S, Yoshimura S, Futami K, Yao T (1992) The postoperative recurrence of Crohn’s disease: an analysis of 37 patients with Crohn’s disease who underwent enteroscopy during initial surgery. Surg Today 22: 346–350PubMedCrossRef Arima S, Yoshimura S, Futami K, Yao T (1992) The postoperative recurrence of Crohn’s disease: an analysis of 37 patients with Crohn’s disease who underwent enteroscopy during initial surgery. Surg Today 22: 346–350PubMedCrossRef
5.
go back to reference Bijnen AB, Schreve RH, Westbroek DL (1987) Calibration of stenosis of the small intestine with marbles. Surg Gynecol Obstet 164: 175PubMed Bijnen AB, Schreve RH, Westbroek DL (1987) Calibration of stenosis of the small intestine with marbles. Surg Gynecol Obstet 164: 175PubMed
6.
go back to reference Enns R, Go K, Chang H, Pluta K (2004) Capsule endoscopy: a single-centre experience with the first 226 capsules. Can J Gastroenterol 18: 555–558PubMed Enns R, Go K, Chang H, Pluta K (2004) Capsule endoscopy: a single-centre experience with the first 226 capsules. Can J Gastroenterol 18: 555–558PubMed
7.
go back to reference Esaki M, Matsumoto T, Hizawa K, Aoyagi K, Mibu R, Iida M, Fujishima M (2001) Intraoperative enteroscopy detects more lesions but is not predictive of postoperative recurrence in Crohn’s disease. Surg Endosc 15: 455–459PubMedCrossRef Esaki M, Matsumoto T, Hizawa K, Aoyagi K, Mibu R, Iida M, Fujishima M (2001) Intraoperative enteroscopy detects more lesions but is not predictive of postoperative recurrence in Crohn’s disease. Surg Endosc 15: 455–459PubMedCrossRef
8.
go back to reference Garcia-Granero E, Esclapez P, Garcia-Armengol J, Espi A, Planelles J, Millan M, Lledo S (2000) Simple technique for the intraoperative detection of Crohn’s strictures with a calibration sphere. Dis Colon Rectum 43: 1168–1170PubMedCrossRef Garcia-Granero E, Esclapez P, Garcia-Armengol J, Espi A, Planelles J, Millan M, Lledo S (2000) Simple technique for the intraoperative detection of Crohn’s strictures with a calibration sphere. Dis Colon Rectum 43: 1168–1170PubMedCrossRef
9.
go back to reference Gasche C, Scholmerich J, Brynskov J, D’Haens G, Hanauer SB, Irvine EJ, Jewell DP, Rachmilewitz D, Sachar DB, Sandborn WJ, Sutherland LR (2000) A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 6: 8–15PubMedCrossRef Gasche C, Scholmerich J, Brynskov J, D’Haens G, Hanauer SB, Irvine EJ, Jewell DP, Rachmilewitz D, Sachar DB, Sandborn WJ, Sutherland LR (2000) A simple classification of Crohn’s disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 6: 8–15PubMedCrossRef
10.
go back to reference Lescut D, Vanco D, Bonniere P, Lecomte-Houcke M, Quandalle P, Wurtz A, Colombel JF, Delmotte JS, Paris JC, Cortot A (1993) Perioperative endoscopy of the whole small bowel in Crohn’s disease. Gut 34: 647–649PubMed Lescut D, Vanco D, Bonniere P, Lecomte-Houcke M, Quandalle P, Wurtz A, Colombel JF, Delmotte JS, Paris JC, Cortot A (1993) Perioperative endoscopy of the whole small bowel in Crohn’s disease. Gut 34: 647–649PubMed
11.
go back to reference Olaison G, Smedh K, Sjodahl R (1992) Natural course of Crohn’s disease after ileocolic resection: endoscopically visualized ileal ulcers preceeding symptoms. Gut 33: 331–335PubMed Olaison G, Smedh K, Sjodahl R (1992) Natural course of Crohn’s disease after ileocolic resection: endoscopically visualized ileal ulcers preceeding symptoms. Gut 33: 331–335PubMed
12.
go back to reference Otterson MF, Lundeen SJ, Spinelli KS, Sudakoff GS, Telford GL, Hatoum OA, Saeian K, Yun H, Binion DG (2004) Radiographic underestimation of small bowel stricturing Crohn’s disease: a comparison with surgical findings. Surgery 136: 854–860PubMedCrossRef Otterson MF, Lundeen SJ, Spinelli KS, Sudakoff GS, Telford GL, Hatoum OA, Saeian K, Yun H, Binion DG (2004) Radiographic underestimation of small bowel stricturing Crohn’s disease: a comparison with surgical findings. Surgery 136: 854–860PubMedCrossRef
14.
go back to reference Poggioli G, Pierangeli F, Laureti S, Ugolini F (2002) Review article: indication and type of surgery in Crohn’s disease. Aliment Pharmacol Ther 16: 59–64PubMedCrossRef Poggioli G, Pierangeli F, Laureti S, Ugolini F (2002) Review article: indication and type of surgery in Crohn’s disease. Aliment Pharmacol Ther 16: 59–64PubMedCrossRef
15.
go back to reference Smedh K (2001) Intraoperative endoscopy to identify strictures in Crohn’s disease. Dis Colon Rectum 44: 601–603PubMedCrossRef Smedh K (2001) Intraoperative endoscopy to identify strictures in Crohn’s disease. Dis Colon Rectum 44: 601–603PubMedCrossRef
16.
go back to reference Smedh K, Olaison G, Nystrom PO, Sjodahl R (1993) Intraoperative enteroscopy in Crohn’s disease. Br J Surg 80: 897–900PubMedCrossRef Smedh K, Olaison G, Nystrom PO, Sjodahl R (1993) Intraoperative enteroscopy in Crohn’s disease. Br J Surg 80: 897–900PubMedCrossRef
17.
go back to reference Smedh K, Olaison G, Sjodahl R (1995) Importance of endoscopically visualized recurrent ileitis and small bowel resection for symptoms in Crohn’s disease. Scand J Gastroenterol 30: 473–477PubMed Smedh K, Olaison G, Sjodahl R (1995) Importance of endoscopically visualized recurrent ileitis and small bowel resection for symptoms in Crohn’s disease. Scand J Gastroenterol 30: 473–477PubMed
19.
go back to reference Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, Ortner MA (2005) Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 54: 369–373PubMedCrossRef Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, Ortner MA (2005) Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut 54: 369–373PubMedCrossRef
Metadata
Title
Role of intraoperative enteroscopy for surgical decision making with Crohn’s disease
Authors
M. Hotokezaka
S-I. Jimi
H. Hidaka
N. Maehara
T-A. Eto
K. Chijiiwa
Publication date
01-07-2007
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 7/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-006-9154-z

Other articles of this Issue 7/2007

Surgical Endoscopy 7/2007 Go to the issue