THE ENDOSCOPIC PICTURE REFLECTS TRANSMURAL INFLAMMATION BETTER THAN ENDOSCOPIC BIOPSY IN CROHNS-DISEASE

Objective: To investigate how the histopathological picture of endosco pic biopsy specimens related to that of transmural sections and also h ow these related to the endoscopic findings. Design: Prospective contr olled study. Patients and methods: Intraoperative endoscopy was perfor med on 19 patients with Crohn's disease and mucosal biopsies were obta ined from various bowel segments that were to be resected. The histopa thological appearance of mucosal biopsies was compared to that of tran smural bowel sections and to endoscopic findings. Ten patients undergo ing surgery for colonic cancer were used as controls.Results: Poor agr eement was found between the pathologist's assessment of biopsy specim ens and transmural bowel sections (kappa < 0.38) for all histological variables. The endoscopic assessment of inflammatory severity had a be tter correlation with global histological assessment of transmural bow el wall sections (r = 0.75) than with a global histological assessment of endoscopic biopsy specimens (r = 0.65). Conclusion: Endoscopic ass essment of inflammation in Crohn's disease better reflects transmural histopathology than mucosal biopsy and thus the severity and extent of inflammation. Routine biopsy sampling is of limited value in Crohn's disease.