Remaining small bowel endoscopic lesions at surgery have no influence on early anastomotic recurrences in Crohn's disease.
OBJECTIVE
We recently demonstrated that 65% of patients operated on for Crohn's disease (CD) had lesions of the small bowel at perioperative endoscopy (POE). These lesions were unrecognized before surgery in more than half of the patients. The aim of this study was to assess the prognostic value of endoscopic small bowel lesions let in place at time of surgery on further anastomotic endoscopic relapse.


METHODS
Twenty one patients (10 women, 11 men, mean age 34 yr) had an enteroscopy from the terminal ileum to the ligament of Treitz during an ileocolectomy performed for CD. All patients were subsequently enrolled in a placebo-controlled trial of mesalazine for the prevention of early endoscopic relapse; 10 patients received placebo, and 11 received mesalazine (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 neoterminal ileum.


RESULTS
POE was completed up to the angle of Treitz in all 21 patients. In 10/21 cases (47%), mild lesions were found distributed at random along the small intestine 30 cm beyond the resection margin. At colonoscopy performed 12 wk later, lesions were found in 11/21 cases (52%) between section margin and were estimated to be 25 cm over the anastomosis. Endoscopic recurrence occurred in 5/10 patients who received placebo and 6/11 patients who received mesalazine. Endoscopic recurrence occurred in 5/10 patients having lesions at POE and in 6/11 patients who had no lesions. There was no relationship between endoscopic recurrence at 12 wk and presence of lesions at initial POE, whatever the postoperative treatment.


CONCLUSIONS
Endoscopic lesions let in place after "curative" surgery have no influence on early endoscopic anastomotic recurrences in CD.
D000328:Adult; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000714:Anastomosis, Surgical; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003082:Colectomy; D003113:Colonoscopy; D003424:Crohn Disease / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology* / Q000601:surgery*; D008297:Male; D019804:Mesalamine; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors
D000636:Aminosalicylic Acids; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine