PERIOPERATIVE ENDOSCOPY OF THE WHOLE SMALL-BOWEL IN CROHNS-DISEASE

The aim of this study was to search for small bowel lesions by means o f a perioperative endoscopy in 20 patients operated on for Crohn's dis ease. Seven women and 13 men (mean age 29 years) had a total retrograd e exploration to the angle of Treitz during an ileocolectomy (16 of 20 patients) or a colonic or ileal resection (four of 20 patients). Endo scopic exploration was completed, through an enterotomy, from the surg ical area to the angle of Treitz. Periendoscopic biopsy samples were t aken on macroscopic lesions and every 20 cm systematically. In 13 of 2 0 cases, various lesions scattered over the whole small intestine were found. These were aphthoid ulcerations (10 patients), superficial ulc erations (seven patients), mucosal oedema (three patients), non-ulcera tive stenosis (three patients), erythema (two patients), pseudopolyps (two patients), deep ulcerations (two patients), and ulcerative stenos is (one patient). In seven patients none of the lesions detected at pe rioperative endoscopy had been recognised by preoperative evaluation o r 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 patie nts 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.