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P133. Small bowel stricture in Crohn's disease: The main factor for surgery indication?

G. Vincoli1, L. Candeloro1, R. Calarco1, E. Corazziari1, N. Pallotta1, 1“Sapienza”, Department of Internal Medicine and Medical Specialties, Rome, Italy

Background

Crohn's disease (CD) progression is characterized by the occurrence of intestinal strictures often requiring surgery. A cohort study showed that 22% of patients with stricturing CD underwent surgery during a 5 years follow-up (FU) interval [1]. It is not known whether the site and severity of stricture defined by its lumen diameter and extent, affect the indication for surgery. Small intestine contrast ultrasonography (SICUS) can assess the maximal intestinal lumen distensibility and, compared to surgical findings [2], has been proven to accurately detect CD small bowel strictures.

Aim: To evaluate in CD patients whether the site, lumen diameter and extent of stricture are associated to obstructive symptoms and the need of surgery.

Methods

Within a long-term prospective FU study that includes clinical, laboratory, and SICUS evaluation performed at regular time intervals independently from symptoms recurrence and preoperatively in those submitted to surgery, 190 CD patients (112 M, mean age 37 yrs) were evaluated. SICUS was performed after the ingestion of 375 ml of macrogol oral solution. The association between site, lumen diameter and extent of strictures was assessed in all patients at SICUS and in those operated comparatively at SICUS and surgery with Mann–Whitney U test.

Results

During a 8±2 yrs FU period 109 patients (57%) developed one or more strictures and 30 (28%) (M 14, B2 25, B3 5, L1 17, L3 13, median age 39 yrs) underwent ileo-colonic resection for intestinal obstruction. The agreement by K-statistics between SICUS and surgery in identifying presence, site and number of strictures was 0.93. The site of strictures was Ileo-cecal valve/anastomosis, terminal, distal and proximal ileum in 15, 44, 11 and 11 of non-operated patients (NOP) and 0, 24, 7 and 6 in operated patients (OP). Extent of strictures was 5.6±3.4 cm at surgery, 5.7±4.1 cm at SICUS (n.s). Pre-stenotic dilatation was present in 49/81 (60%) and 15/37 (40.5%) strictures in NOP and OP, respectively (n.s). The extent and lumen diameter of strictures were 5±5 cm and 6±1 mm in NOP and 6.6±5 cm and 5.2±1.8 mm in OP (n.s), respectively. There was no significant difference in the stricture site between OP and NOP.

Conclusion

Site, extent and degree of luminal narrowing of stricture do not differ between CD patients requiring and not requiring surgery. Severity of stricture does not appear to be the only determinant for surgery. It is likely that other factors contribute to indicate surgery.

1. Cosnes J et al IBD 2002

2. Pallotta N et al IBD 201.