Long-term follow-up of strictureplasty for Crohn's disease

Fearnhead, Nicola; Chowdhury, Ranadip; Box, B; George, Bruce; Jewell, D P; Mortensen, N. J. McC.

doi:10.1002/bjs.5179

Cited by 73 publications

(46 citation statements)

References 72 publications

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“…It has been clearly shown that CD strictures can be treated by strictureplasty instead of resection [19][20][21][22][23][24][25][26] . The regression of inflammatory activity of CD at the strictureplasty site has been well documented by radiological, ultrasonographic, endoscopic or histological investigations [27][28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

Is lymphatic status related to regression of inflammation in Crohn's disease?

Tonelli

Giudici²,

Liscia³

2012

WJGS

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AIM:To investigate the status of the lymphatic vessels in the small bowel affected by Crohn's disease (CD) at the moment of surgery. METHODS:During the period January 2011-June 2011, 25 consecutive patients affected by CD were operated on in our Institution. During surgery, Patent Blue Ⅴ was injected subserosally and the way it spread along the subserosa of the intestinal wall, through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and recorded. Since some patients had been undergone strictureplasty at previous surgery, we also examined the status of intestinal lymph vessels after previous strictureplasties. The same procedure was performed in a control group of 5 patients affected by colorectal cancer. Length of lesions, caliber, maximal thickness of the diseased intestinal wall, thickness of the wall at injection site and thickness of the mesentery were evaluated at surgery. RESULTS:We observed three features after the injection of Patent Blue Ⅴ in the intestinal loops: (1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery; (2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness, we observed short, wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery; and (3) Injection in the severely affected lesions, that had a thickness of the intestinal wall over 10 mm, did not show any feature of lymphatic vessels at least on the subserosal surface. There was a correlation between the thickness of the parietal wall and the severity of the lymphatic alterations. Normal lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the inflammation. CONCLUSION:Injection of Patent Blue Ⅴ in the intestinal wall could help distinguish healthy tracts of the small bowel from those macroscopically borderline.

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Section: Discussionmentioning

confidence: 99%

Is lymphatic status related to regression of inflammation in Crohn's disease?

Tonelli

Giudici²,

Liscia³

2012

WJGS

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“…Warunkiem bezpiecznego poszerzenia endoskopowego jest brak owrzodzeń oraz krótki odcinek zwężenia (do 4 cm). Alternatywną metodą jest chirurgiczna plastyka zwężeń [101,102] (zwłaszcza u chorych zagrożonych zespołem krótkiego jelita, ze zwężeniami krótszymi niż 10 cm), a w przypadku długiego odcinka lub zwężeń wielopoziomowych oraz aktywnych zmian w zwężeniu -resekcja odcinkowa jelita [103]. Chirurgiczna plastyka zwężeń w jelicie grubym oraz wytworzenie zbiornika J-pouch nie są zalecane osób z ChLC.…”

Section: Le Ec Cz Ze En Ni Ie E C Ch Hi Ir Ru Ur Rg Gi Ic Cz Zn Ne Eunclassified

Guidelines for the management of Crohn’s disease. Recommendations of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology

Łodyga¹,

Eder²,

Bartnik³

et al. 2012

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“…No entanto, Lashner 16 questiona essa afirmação, sugerindo que o risco não aumenta simplesmente pela exclusão de alça e, sim, pela presença de alças intestinais com doença ativa por longo tempo, predispondo ao desenvolvimento neoplásico. O fato é que as anuloplastias não parecem predispor ao aparecimento de câncer 21 .…”

Section: Discussionunclassified

Câncer em doença de Crohn: relato de caso

Valério

Cutait

Sipahi

et al. 2006

Rev bras. colo-proctol.

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RESUMO: Apesar de se reconhecer que existe um maior risco de câncer em portadores de doença de Crohn (DC), até o presente momento foram descritos menos de 150 casos na literatura mundial. Os principais fatores de risco são a instalação precoce, a longa evolução da doença, a ocorrência de doença fistulosa crônica e a presença de alça exclusa comprometida. Relato de caso. Paciente MCAN, de 53 anos de idade, do sexo feminino, de cor branca, havia sido submetida à ileocolectomia direita aos 17 anos, por obstrução intestinal, decorrente de DC em íleo distal. Há um ano, devido a novo quadro obstrutivo, foi submetida a laparotomia exploradora quando se encontrou massa na região da anastomose ileocólica, caracterizada como adenocarcinoma mucossecretor. Discussão: Na maioria dos casos relatados, o câncer instala-se muitos anos após o início dos sintomas, ocorrendo em cerca de 80% dos pacientes após 20 anos do diagnóstico de DC. O tumor é habitualmente de crescimento insidioso e leva à obstrução intestinal. Apenas 10% dos pacientes sobrevivem dois anos livres da doença. O presente caso mostra características identificadas na maioria dos pacientes com DC que desenvolvem neoplasia de intestino delgado: tumor se desenvolvendo muitos anos após a instalação da enfermidade e com comportamento agressivo. Descritores RELATO DE CASOA paciente M.C.A.N., de 53 anos de idade, do sexo feminino, de cor branca, foi submetida, aos 17 anos de idade, à ileocolectomia direita por obstrução intestinal, decorrente de DC que comprometia o íleo distal. Desde então, apresentava ocasionalmente dores abdominais em cólica. Com 52 anos desenvolveu quadro de obstrução intestinal, tendo sido submetida à

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Long-term follow-up of strictureplasty for Crohn's disease

Abstract: Long-term follow-up has confirmed the safety of strictureplasty in Crohn's disease. Morbidity is appreciable, although the surgical mortality rate is low. Reoperation rates are comparable following first and repeat strictureplasty procedures.

Cited by 73 publications

References 72 publications

Is lymphatic status related to regression of inflammation in Crohn's disease?

Is lymphatic status related to regression of inflammation in Crohn's disease?

Guidelines for the management of Crohn’s disease. Recommendations of the Working Group of the Polish National Consultant in Gastroenterology and the Polish Society of Gastroenterology

Câncer em doença de Crohn: relato de caso

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