INTRAOPERATIVE ENTEROSCOPY IN CROHNS-DISEASE

Intraoperative small bowel endoscopy was performed on 33 occasions in 31 patients with Crohn's disease. The extent of mucosal inflammation w as compared with that of changes in the external bowel wall: serositis , fat-wrapping and mural thickening. The influence of endoscopic findi ngs on surgical management was evaluated. Mucosal inflammation was gen erally more extensive than serositis (P < 0.01), but less so than mura l thickening (P < 0.001). The extent of fat-wrapping did not differ fr om that of mucositis. Of 23 patients undergoing reoperation or with fi stula or abscess, however, eight had serositis and/or fat-wrapping in bowel segments without mucosal inflammation. Endoscopic findings influ enced surgical decisions on 20 of the 33 occasions, limiting planned r esection in 14, identifying strictures for repair in one, and deciding against resection in two cases and for extended resection in three. T hese results suggest that external inflammatory changes are unreliable guides to the extent of intestinal mucositis and requirements for res ection in Crohn's disease. By visualizing the mucosa, intraoperative e nteroscopy can provide information for more precise surgery, thereby l imiting resection.