Skip to main content

Intraoperative Detection of Upper Gastrointestinal Strictures

  • Chapter
  • First Online:
Mastery of IBD Surgery

Abstract

Operative intervention for Crohn’s disease must include careful assessment of the entire gastrointestinal tract for additional disease that may require intervention. Numerous methods for intraoperative stricture detection are available to the surgeon including palpation, balloon catheter trawl, ball calibration and intraoperative endoscopy. This chapter outlines the evidence for each, their advantages and drawbacks, including personal recommendations on intraoperative stricture detection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231:38–45.

    Article  CAS  Google Scholar 

  2. Mege D, Panis Y. Unmet therapeutic needs: focus on intestinal fibrosis surgical approach: resection, strictureplasty and others. Dig Dis. 2017;35:38–44.

    Article  Google Scholar 

  3. Baumgart DC, Sandborn WJ. Crohn’s disease. Lancet. 2012;380:1590–605.

    Article  Google Scholar 

  4. Chan G, Fefferman DS, Farrell RJ. Endoscopic assessment of inflammatory bowel disease: colonoscopy/esophagogastroduodenoscopy. Gastroenterol Clin N Am. 2012;41:271–90.

    Article  Google Scholar 

  5. Burke JP, Mulsow JJ, O’Keane C, Docherty NG, Watson RW, O’Connell PR. Fibrogenesis in Crohn’s disease. Am J Gastroenterol. 2007;102:439–48.

    Article  CAS  Google Scholar 

  6. Cosnes J, Nion-Larmurier I, Beaugerie L, Afchain P, Tiret E, Gendre JP. Impact of the increasing use of immunosuppressants in Crohn’s disease on the need for intestinal surgery. Gut. 2005;54:237–41.

    Article  CAS  Google Scholar 

  7. Chang CW, Wong JM, Tung CC, Shih IL, Wang HY, Wei SC. Intestinal stricture in Crohn’s disease. Intestinal research. 2015;13:19–26.

    Article  Google Scholar 

  8. Lazarev M, Ullman T, Schraut WH, Kip KE, Saul M, Regueiro M. Small bowel resection rates in Crohn’s disease and the indication for surgery over time: experience from a large tertiary care center. Inflamm Bowel Dis. 2010;16:830–5.

    Article  Google Scholar 

  9. Almer S, Granerus G, Strom M, Olaison G, Bonnet J, Lemann M, Smedh K, Franzen L, Bertheau P, Cattan P, Rain JD, Modigliani R. Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn’s disease. Inflamm Bowel Dis. 2007;13:164–74.

    Article  Google Scholar 

  10. Hotokezaka M, Jimi SI, Hidaka H, Maehara N, Eto TA, Chijiiwa K. Role of intraoperative enteroscopy for surgical decision making with Crohn’s disease. Surg Endosc. 2007;21:1238–42.

    Article  CAS  Google Scholar 

  11. Otterson MF, Lundeen SJ, Spinelli KS, Sudakoff GS, Telford GL, Hatoum OA, Saeian K, Yun H, Binion DG. Radiographic underestimation of small bowel stricturing Crohn’s disease: a comparison with surgical findings. Surgery. 2004;136:854–60.

    Article  Google Scholar 

  12. Dietz DW, Laureti S, Strong SA, Hull TL, Church J, Remzi FH, Lavery IC, Fazio VW. Safety and longterm efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn’s disease. J Am Coll Surg. 2001;192:330–7.. discussion 337-338

    Article  CAS  Google Scholar 

  13. Fazio VW, Tjandra JJ, Lavery IC, Church JM, Milsom JW, Oakley JR. Long-term follow-up of strictureplasty in Crohn’s disease. Dis Colon Rectum. 1993;36:355–61.

    Article  CAS  Google Scholar 

  14. Olaison G, Andersson P, Myrelid P, Smedh K, Söderholm J, Sjödahl R. On-table endoscopy to define strictures and resection margins: experience from 178 operations for Crohn’s disease using intraoperative endoscopy. Color Dis. 2001;3:58–62.

    Article  Google Scholar 

  15. Dehn TC, Kettlewell MG, Mortensen NJ, Lee EC, Jewell DP. Ten-year experience of strictureplasty for obstructive Crohn’s disease. Br J Surg. 1989;76:339–41.

    Article  CAS  Google Scholar 

  16. Arima S, Yoshimura S, Futami K, Yao T. The postoperative recurrence of Crohn’s disease: an analysis of 37 patients with Crohn’s disease who underwent endoscopy during initial surgery. Surg Today. 1992;22:346–50.

    Article  CAS  Google Scholar 

  17. Esaki M, Matsumoto T, Hizawa K, Aoyagi K, Mibu R, Iida M, Fujishima M. Intraoperative enteroscopy detects more lesions but is not predictive of postoperative recurrence in Crohn’s disease. Surg Endosc. 2001;15:455–9.

    Article  CAS  Google Scholar 

  18. Lescut D, Vanco D, Bonniere P, Lecomte-Houcke M, Quandalle P, Wurtz A, Colombel JF, Delmotte JS, Paris JC, Cortot A. Perioperative endoscopy of the whole small bowel in Crohn’s disease. Gut. 1993;34:647–9.

    Article  CAS  Google Scholar 

  19. Smedh K, Olaison G, Nystrom PO, Sjodahl R. Intraoperative enteroscopy in Crohn’s disease. Br J Surg. 1993;80:897–900.

    Article  CAS  Google Scholar 

  20. Garcia-Granero E, Esclapez P, Garcia-Armengol J, Espi A, Planelles J, Millan M, Lledo S. Simple technique for the intraoperative detection of Crohn’s strictures with a calibration sphere. Dis Colon Rectum. 2000;43:1168–70.

    Article  Google Scholar 

  21. Stebbing JF, Jewell DP, Kettlewell MG, Mortensen NJ. Recurrence and reoperation after strictureplasty for obstructive Crohn’s disease: long-term results [corrected]. Br J Surg. 1995;82:1471–4.

    Article  CAS  Google Scholar 

  22. Luke D, Bowley D, Mortensen N. Calibration of the small bowel in stricture-forming small-bowel Crohn’s disease. Ann R Coll Surg Engl. 2015;97:81–2.

    Article  CAS  Google Scholar 

  23. Bijnen AB, Schreve RH, Westbroek DL. Calibration of stenosis of the small intestine with marbles. Surg Gynecol Obstet. 1987;164:175.

    CAS  PubMed  Google Scholar 

  24. Cundall JD, Rogers C. Detection of Crohn’s strictures--the use of an ’Endo-marble. Ann R Coll Surg Engl. 2001;83:172–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Alexander-Williams J, Haynes IG. Conservative operations for Crohn’s disease of the small bowel. World J Surg. 1985;9:945–51.

    Article  CAS  Google Scholar 

  26. Olaison G, Smedh K, Sjodahl R. Natural course of Crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992;33:331–5.

    Article  CAS  Google Scholar 

  27. Hotokezaka M, Jimi S, Hidaka H, Eto TA, Chijiiwa K. Intraoperative enteroscopy in minimally invasive surgery. Surg Laparosc Endosc Percutan Tech. 2007;17:492–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Neil J. Mortensen .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Barnes, T.G., Mortensen, N.J. (2019). Intraoperative Detection of Upper Gastrointestinal Strictures. In: Hyman, N., Fleshner, P., Strong, S. (eds) Mastery of IBD Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16755-4_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16755-4_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16754-7

  • Online ISBN: 978-3-030-16755-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics