REMAINING SMALL-BOWEL ENDOSCOPIC LESIONS AT SURGERY HAVE NO INFLUENCEON EARLY ANASTOMOTIC RECURRENCES IN CROHNS-DISEASE

Objectives: We recently demonstrated that 65% of patients operated on for Crohn's disease (CD) had lesions of the small bowel at perioperati ve endoscopy (POE). These lesions were unrecognized before surgery in more than half of the patients. The aim of this study was to assess th e prognostic value of endoscopic small bowel lesions let in place at t ime of surgery on further anastomotic endoscopic relapse, Methods: Twe nty one patients (10 women, 11 men, mean age 34 yr) had an enterosocop y from the terminal ileum to the ligament of Treitz during an ileocole ctomy performed for CD. All patients were subsequently enrolled in a p lacebo-controlled trial of mesalazine for the prevention of early endo scopic relapse; 10 patients received placebo, and 11 received mesalazi ne (1.5 g/day) for 12 wk after surgery. At the end of this trial, they all had a colonoscopy with inspection of the anastomosis and the neot erminal ileum. Results: POE was completed up to the angle of Treitz in all 21 patients. In 10/21 cases (47%), mild lesions were found distri buted at random along the small intestine 30 cm beyond the resection m argin. At colonoscopy performed 12 wk later, lesions were found in 11/ 21 cases (52%) between section margin and were estimated to be 25 cm o ver the anastomosis. Endoscopic recurrence occurred in 5/10 patients w ho received placebo and 6/11 patients who received mesalazine. Endosco pic recurrence occurred in 5/10 patients having lesions at POE and in 6/11 patients who had no lesions. There was no relationship between en doscopic recurrence at 12 wk and presence of lesions at initial POE, w hatever the postoperative treatment. Conclusion: Endoscopic lesions le t in place after ''curative'' surgery have no influence on early endos copic anastomotic recurrences in CD.