P134. Small bowel prestenotic dilatation is not related to severity degree of stricture and to surgical indication in Crohn's disease (CD) patients
G. Vincoli1, L. Candeloro1, R. Calarco1, E. Corazziari1, N. Pallotta1, 1“Sapienza”, Department of Internal Medicine and Medical Specialties, Rome, Italy
Crohn's disease (CD) patients can develop lifetime clinical symptoms of intestinal obstruction which require a proper diagnostic work-up. At imaging the definition of stricture is not standardized, and the presence of pre-stenotic dilatation has been widely considered the hallmark of fibrotic stricture, often requiring surgery. Small intestine contrast ultrasonography (SICUS) has been proven to be as accurate as surgical assessment of small bowel (SB) strictures in CD . SICUS can measure the length and, for its distinctive ability and differently from TC and RMN to prolong the observation time, the maximal lumen distensibility of the stenotic tract. AIM To evaluate in CD patients whether: a) the site, lumen diameter and/or the extent of SB stricture are associated to the presence and severity degree of pre-stenotic dilatation and b) The pre-stenotic dilatation is associated with the surgical indication.
Within a long-term prospective follow-up (FU) study in a IBD referral center 190 patients (M 112, mean age 37±16 yrs) were evaluated. SICUS was performed at regular FU intervals and preoperatively in patients undergoing surgery after the ingestion of 375 ml of macrogol oral solution. The association between site, lumen diameter and extent of strictures and the presence and lumen diameter of pre-stenotic dilatation were assessed at SICUS and in operated patients at SICUS and surgery with Student's t-Test and linear regression analysis.
During the FU 109/190 developed one or more stricture and 40 (M 19, B2 32, B3 7, L1 21, L3 18, mean age 33 yrs) underwent ileo-colonic resection. 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, 36, 9 and 7 in operated patients (OP). The agreement by K-statistics between SICUS and surgical findings in identifying presence, site of strictures and pre-stenotic dilatation was 0.93. Extent of strictures was 5.6±3.4 cm at surgery, 5.7±4 cm at SICUS (n.s). Prestenotic dilatation was present in 49/81 (60%) and 27/52 (52%) 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 6.6±1.8 mm in OP (n.s), respectively and 5.7±3 cm and 6.2±2 mm and 6±2 cm and 5.4±2 mm in OP with and without prestenotic dilatation. There was not significant association between extent and lumen diameter and site of stricture and presence and lumen diameter of prestenotic dilatation in OP and in NOP.
Site, length and, lumen diameter of SB strictures are not associated with prestenotic dilatation. The presence of strictures with prestenotic dilatation is not associated with surgical indication.
1. Pallotta N et al IBD 2011