Radiographic underestimation of small bowel stricturing Crohn's disease: a comparison with surgical findings. Surgery 2004 Oct;136(4):854-60
Date
10/07/2004Pubmed ID
15467672DOI
10.1016/j.surg.2004.06.023Scopus ID
2-s2.0-4744368805 (requires institutional sign-in at Scopus site) 45 CitationsAbstract
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.
Author List
Otterson MF, Lundeen SJ, Spinelli KS, Sudakoff GS, Telford GL, Hatoum OA, Saeian K, Yun H, Binion DGAuthors
Mary F. Otterson MD Professor in the Surgery department at Medical College of WisconsinKia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Barium Sulfate
Body Weights and Measures
Catheterization
Constriction, Pathologic
Contrast Media
Crohn Disease
Digestive System Surgical Procedures
Female
Humans
Intestine, Small
Male
Middle Aged
Radiography
Retrospective Studies
