Radiographic underestimation of small bowel stricturing Crohn's disease: a comparison with surgical findings.
BACKGROUND
The purpose of this study was to determine the accuracy of barium radiography compared with intraoperative evaluation with passage of a balloon catheter for assessment of stricturing Crohn's disease (CD).


METHODS
After institutional review board approval, we retrospectively reviewed a tertiary inflammatory bowel disease center's consecutive records of surgical patients between 1998 and 2003 with small intestinal CD to compare the number of strictures found at surgery with those identified preoperatively by barium imaging. Age, gender, prior surgical procedures, and steroid usage were recorded. By decision of the surgeons, all patients were treated with an identical approach that utilized intraluminal sizing with passage of a balloon-tipped catheter.


RESULTS
In 118 patients, 230 strictures were identified by barium examination; 365 strictures were identified using the balloon catheter technique. Barium examination overestimated or underestimated the number of strictures in 43 of 118 patients (36%). Overall, barium radiography was least accurate in patients with strictures amenable to strictureplasty. Prior surgery and multiple strictures identified preoperatively by barium studies were found to decrease the accuracy of the barium examination, but the decrease did not reach statistical significance. After successful surgery for stricturing small intestinal CD, more than 90% of patients can successfully be weaned from their steroids within 3 months. Failure to be able to wean from steroids may suggest a missed stricture.


CONCLUSIONS
Our data suggest that careful exploration and intraoperative, intraluminal testing of intestinal patency identify additional strictures compared with barium radiographs in a significant number of patients with CD undergoing small bowel surgical intervention.
Otterson
Mary F
MF
Department of Surgery, Medical College of Winsconsin, Milwaukee 53226, USA.
Lundeen
Sarah J
SJ
Spinelli
Kristine S
KS
Sudakoff
Gary S
GS
Telford
Gordon L
GL
Hatoum
Ossama A
OA
Saeian
Kia
K
Yun
Hyun
H
Binion
David G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D001837:Body Weights and Measures; D002404:Catheterization / Q000295:instrumentation; D003251:Constriction, Pathologic; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies
D003287:Contrast Media; D001466:Barium Sulfate