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 21 January 2018

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News

Radiographic underestimation of small bowel stricturing in CD

A retrospective study in October's issue of Surgery finds that careful exploration and intraoperative, intraluminal testing of intestinal patency identifies additional strictures compared with barium radiographs.

News image

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Dr Mary Otterson and fellow researchers in Milwaukee, Wisconsin carried out a study to determine the accuracy of barium radiography compared with intraoperative evaluation with passage of a balloon catheter for assessment of stricturing Crohn's disease (CD).

The research group retrospectively reviewed a tertiary inflammatory bowel disease center's consecutive records of surgical patients between 1998 and 2003.

The research team included patients with small intestinal CD in the study.

The team then compared the number of strictures found at surgery with those identified preoperatively by barium imaging.

The researchers also noted the age, gender, prior surgical procedures, and steroid usage of each participant.

The surgeons decided that patients should be treated with an identical approach that utilized intraluminal sizing with passage of a balloon-tipped catheter.

Barium examination overestimated or underestimated the number of strictures in 36% of patients
Surgery

The team found that out of 118 patients, 230 strictures were identified by barium examination and 365 strictures were identified using the balloon catheter technique.

Barium examination overestimated or underestimated the number of strictures in 36% of patients.

In addition, the researchers found that barium radiography was least accurate overall in patients with strictures amenable to strictureplasty.

Prior surgery and multiple strictures identified preoperatively by barium studies were found to decrease the accuracy of the barium examination, but the decrease did not reach statistical significance.

The group concluded, "After successful surgery for stricturing small intestinal CD, more than 90% of patients can successfully be weaned from their steroids within 3 months."

"Failure to be able to wean from steroids may suggest a missed stricture."

Dr Otterson concluded, "Our data suggest that careful exploration and intraoperative, intraluminal testing of intestinal patency identify additional strictures compared with barium radiographs in a significant number of patients with CD undergoing small bowel surgical intervention."

Surgery; 2004: 136 (4): 854
14 October 2004

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