Background: The majority of Crohn's disease (CD) patients will undergo surgery because of CD complications. To determine the extent of the resection, endoscopy and cross-sectional imaging prior surgery, as well as intraoperative assessment by surgeon might not be sufficient. Intraoperative endoscopy can be of value in guiding the extent of resection but the data on its safety and usefulness in this setting are scarce.
The aim of our study was thus first, to analyze the safety of intraoperative endoscopy. Second, we aimed to determine its impact on the extent of the resection.
Methods: All CD patients operated on in one referral center from January 2015 till October 2016 were included. Intraoperative endoscopy was performed in case of unclear disease extent based on cross-sectional imaging and/or endoscopy prior surgery. Duration of surgery and hospital stay, C-reactive protein, procalcitonin, white blood cells count and rate of complications (anastomotic leak, abscess, re-admission) were noted. The differences between endoscopy and no endoscopy group were analyzed statistically. In addition, the impact of intraoperative endoscopy findings on the extent of the resection was determined.
Results: In total, 41 CD patients underwent surgery (25 laparotomies, 9 laparoscopic and 7 single port laparoscopic surgeries) because of stricturing (25pts), penetrating (14pts) disease complications or treatment failure (2pts). Nineteen intraoperative endoscopies were performed in 17 pts (8 enteroscopies, 1 gastroscopy, 10 colonoscopies).
The endoscopy group had significantly longer median hospital stay compared with the group without endoscopy (respective medians of 6 vs. 5 days, p=0.03). There were no significant differences between the two groups with regards to the duration of the surgery (respective medians 160 vs 135 minutes - endoscopy vs no endoscopy group, p=0.15). C-reactive protein, procalcitonine levels and white blood cells were numerically higher in the endoscopy group during the first five postoperative days but the difference was not statistically significant.
Complications occurred in one out of 17 patients in the endoscopy group (intraabdominal abscess) and in one out of 24 patients in the non-endoscopy group (bleeding from the anastomosis) (p=n.s.).
Twelve out of 19 intra-operative endoscopies provided the information that led to change in the extent of resection (5 reductions and 7 extensions of the to be resected segment) compared with the extent planned based on the cross-sectional imaging and the intraoperative judgment by surgeon.
Conclusions: Intraoperative endoscopy is a safe and useful tool helping to tailor the extent of surgery in complicated Crohn's disease.