On-table endoscopy to define strictures and resection margins: experience from 178 operations for Crohn's disease using intraoperative endoscopy

Abstract Background and Aims The pathogenesis and risk factors for early postoperative endoscopic recurrence of Crohn’s disease [CD] remain unclear. Thus, this study aimed to identify whether histological inflammation at the resection margins after an ileocaecal resection influences endoscopic recurrence. Methods We have prospectively followed up patients with CD who underwent ileocaecal resection at our hospital between January 2012 and January 2018. The specimens were histologically analysed for inflammation at both of the resection margins [ileal and colonic]. We evaluated whether histological results of the resection margins are correlated with endoscopic recurrence of CD based on colonoscopy 6 months after ileocaecal resection. Second, we assessed the influence of known risk factors and preoperative therapy on endoscopic recurrence of CD. Results A total of 107 patients were included in our study. Six months after ileocaecal resection, 23 patients [21.5%] had an endoscopic recurrence of CD. The histological signs of CD at the resection margins were associated with a higher endoscopic recurrence [56.5% versus 4.8%, p < 0.001]. Disease duration from diagnosis to surgery [p = 0.006] and the length of the resected bowel [p = 0.019] were significantly longer in patients with endoscopic recurrence. Smoking was also proved to be a risk factor for endoscopic recurrence [p = 0.028]. Conclusions Histological inflammation at the resection margins was significantly associated with a higher risk of early postoperative endoscopic recurrence after an ileocaecal resection for CD.

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486 Are Surgical Resection Margins A Risk Factor for Crohn’s Disease Recurrence?

British Journal of Surgery ◽

10.1093/bjs/znab134.288 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A A Haiduc ◽

R Patel ◽

A Karim

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Surgical Resection ◽

Colonic Resection ◽

Sufficient Evidence ◽

Resection Margins ◽

Related Factors ◽

Clinical Recurrence ◽

Disease Free

Abstract Despite advances in treatment, Crohn’s disease (CD) recurrence is still high. Various factors correlated with recurrence are studied however, there is no consensus regarding the importance of disease-free resection margins. Our goal was to ascertain whether surgical margins predict recurrence rates of CD and identify other potential factors correlated with recurrence. This is a retrospective cohort study on patients who have had a colonic resection for CD from December 2016 to November 2019. Demographics, surgical procedure details, disease activity at resection margins and number of readmissions were recorded. Clinical recurrence was defined as readmission to hospital for a Crohn’s related flare-up within 12 months of surgical resection. Positive disease activity at the resection margins was defined histologically. We compared the readmission rate between all categories. Of the 55 patients identified, 52 (22 female) were included. Of these, seven were readmitted, six are smokers, 19 had mesenteric excision and 33 had Crohn’s positive resection margins. Chi-squared tests showed there are no significant correlations between patient and procedure variables, and readmission rates (p > 0.05). We have not found sufficient evidence to conclude that a disease-free resection margin post colonic resection or any other patient-related factors are associated with decreased recurrence of CD.

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P375 Intraoperative endoscopy is safe and helps to determine the resection extent in Crohn's disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.500 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S268-S268

Author(s):

D. Podmanicky ◽

V. Stefanov ◽

D. Harustiakova ◽

J. Kovacs ◽

Z. Zelinkova

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intraoperative Endoscopy

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The Occurrence of Postoperative Complications in Patients Undergoing Surgery due to Complications from Crohn's Disease: A Case Report

Acta Facultatis Medicae Naissensis ◽

10.2478/afmnai-2018-0008 ◽

2018 ◽

Vol 35 (1) ◽

pp. 73-80

Author(s):

Vladimir Joksimović ◽

Nikola Jankulovski ◽

Svetozar Antović ◽

Marija Joksimović ◽

Ljubinka Mančeva

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Surgical Treatment ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Resection Margins ◽

Chronic Inflammatory Condition ◽

Positive Resection Margins ◽

Low Levels ◽

Emergent Case

Summary Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum or anus. Less commonly, it affects the stomach, esophagus and mouth. Often, the disease affects multiple areas of the gastrointestinal tract. The cause of CD is not known and there is no curative treatment. The current medical and surgical treatment is effective in controlling the disease, but even with optimal treatment, recurrences and relapses are frequent. Various risk factors specific for the patients with conditions related to the CD can influence the outcome of the surgical treatment in the postoperative period. Those risk factors can be preoperative laboratory inflammatory markers such as WBC and CRP values, phlegmona of the anterior abdominal wall and preoperative interintestinal abscess, positive resection margins. Here we present a case of a patient who was surgically treated as an emergent case because of the complication due to Crohn's disease. At presentation, the patient had leukocytosis, elevated CRP, anemia, low levels of total proteins, and albumin.

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