Early vascular changes in Crohn's disease: An endoscopic fluorescence study

Background and Study Aims: Early recurrent lesions occurring after surgery in Crohn's disease may be the result of localized vasculitis, The aim of th is study was use fluorescence endoscopy to evaluate the mucosal microcircul ation of the neoterminal ileum in relation to endoscopic recurrence in pati ents who had undergone ileocolonic resection for Crohn's disease. Patients and Methods: Ten patients were prospectively enrolled in an endosc opic follow-up study one year after surgery. Recurrence was assessed using routine and fluorescence endoscopy, Biopsies were taken from fluorescent an d nonfluorescent sites to look for inflammation and mucosal vascular lesion s using standard histological and immunohistochemical methods. Results: Endoscopic recurrence mas found in eight patients. irt fluorescenc e endoscopy, the mucosa displayed a heterogeneous pattern, with fluorescent areas corresponding to aphthoid ulcerations; fluorescent rims surrounding dark zones, corresponding to stellar deep ulcers; and smalt bright spots di stributed singly in the mucosa, which appeared normal on routine endoscopy, Histology revealed inflammatory changes with evidence of vascular involvem ent in 79% of the biopsies taken from the fluorescent spots. Conclusions: Endoseopic recurrence in Crohn's disease is associated with fl uorescent aspects that mag reflect vasodilation associated with inflammatio n, or genuine microvascular lesions. Correlation with the histological find ings suggests that these early vascular lesions were secondary to the infla mmatory process.