Endoscopic Evaluation and Management of the Postoperative Crohn's Disease Patient - 14/09/16

Doi : 10.1016/j.giec.2016.06.003

Jana G. Hashash, MD, MSc ^a, David G. Binion, MD, AGAF ^b,^⁎
^a Division of Gastroenterology, Hepatology and Nutrition, UPMC-Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Mezzanine Level C Wing PUH, Pittsburgh, PA 15213, USA
^b Division of Gastroenterology, Hepatology and Nutrition, Clinical and Translational Science, UPMC-Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Mezzanine Level C Wing PUH, Pittsburgh, PA 15213, USA

^∗Corresponding author.

Résumé

Approximately 70% of patients with Crohn's disease (CD) undergo surgical resection for the treatment of medically refractory disease or its complications. The sickest cohort of CD patients experience rapid postoperative relapse at the anastomotic site. Over the past 2 decades, the types of surgical anastomoses used in CD reconstruction have changed; end-to-side and end-to-end anastomoses have been surpassed by the more rapidly created side-to-side anastomoses. This article provides a review of the timing and purpose of endoscopic evaluation in postoperative CD patients and pragmatic information regarding interpretation of endoscopic findings at the different types of surgical anastomoses after ileocecal resection.

Le texte complet de cet article est disponible en PDF.

Keywords : Crohn's disease, Side-to-side anastomosis, End-to-end anastomosis, End-to-side anastomosis, Rutgeerts endoscopic score, Anastomotic stricture, Balloon dilatation

Plan

Key points

Introduction

Surgery and Crohn's disease: assessing postoperative Crohn's disease recurrence

Endoscopic assessment of the Crohn's disease anastomosis: gauging postoperative recurrence and tailoring therapy

Practical guidance: endoscopic evaluation guides management of postoperative Crohn's disease

Postoperative surgical anatomy in Crohn's disease: pragmatic approach to endoscopic assessment of the anastomotic configuration

End-to-End Ileocolonic Anastomosis

End-to-Side Ileocolonic Anastomosis

Side-to-Side Ileocolonic Anastomosis

Endoscopic balloon dilation and steroid injection in anastomotic strictures

Summary

Disclosure Statement: Dr J.G. Hashash: Nothing to disclose. Dr D.G. Binion has received consulting honoraria from Janssen Biotech and UCB Pharma as well as grant support from Janssen Biotech, UCB Pharma, and Merck.