Stricturing Small Bowel Crohn’s Disease (Literature Review)
https://doi.org/10.24060/2076-3093-2024-14-1-52-59
Abstract
One-third of Crohn’s disease patients suffer from isolated small bowel lesions, 10% of whom immediately develop the stricturing form of this disease. In such patients, the diagnosis is often made only on the operating table in the setting of complications. Moreover, following small bowel resection, anastomosis strictures develop in 80% of cases. Of interest are the data of foreign authors on the decrease in the recurrences of small bowel strictures following resection in patients with maximal excision of the associated mesentery. In this connection, research on the possible role of small bowel mesentery in the pathogenesis of Crohn’s disease seems relevant. If this is the case, the optimal surgical treatment consists in performing a resection of the strictured part of the small bowel with the maximal excision of the mesentery of the affected segment and with the creation of a side-to-side antimesenteric anastomosis, excluding the contact of the anastomosis with the remaining part of the mesentery. The article presents a modern literature review on the pathogenesis of the structuring form of small bowel Crohn’s disease, its diagnostic specifics, and the selection of a treatment method, as well as original photo materials.
About the Authors
L. R. Aitova
Bashkir State Medical University
Russian Federation
Russian Federation
Lilia R. Aitova — Cand. Sci. (Med.), Department of Faculty Surgery
Ufa
E. E. Grishina
Bashkir State Medical University
Russian Federation
Russian Federation
Elena E. Grishina — Cand. Sci. (Med.), Department of Faculty Surgery
Ufa
E. M. Sakaev
Bashkir State Medical University
Russian Federation
Russian Federation
Ernest M. Sakaev — Cand. Sci. (Med.), Department of Faculty Surgery
Ufa
V. S. Shchekin
Institute of Fundamental Medicine, Bashkir State Medical University
Russian Federation
Russian Federation
Vlas S. Shchekin — Cand. Sci. (Med.), Scientific Morphology Laboratory
Ufa
References
1. Ranasinghe I.R., Hsu R. Crohn Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Feb 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436021/
2. Myrelid P., Soop M., George B.D. Surgical planning in penetrating abdominal Crohn’s disease. Front Surg. 2022;9:867830. DOI: 10.3389/fsurg.2022.867830
3. Hibiya S., Ohtsuka K., Takenaka K., Kawamoto A., Matsuyama Y., Udagawa Y., et al. Mucosal healing of small intestinal stricture is associated with improved prognosis post-dilation in Crohn’s disease. BMC Gastroenterol. 2022;22(1):218. DOI: 10.1186/s12876-022-02300-2
4. 2015 European Society of Coloproctology collaborating group. Risk factors for unfavourable postoperative outcome in patients with Crohn’s disease undergoing right hemicolectomy or ileocaecal resection An international audit by ESCP and S-ECCO. Colorectal Dis. 2017, Sep 15. DOI: 10.1111/codi.13889
5. Li Y., Mohan H., Lan N., Wu X., Zhou W., Gong J., et al. Mesenteric excision surgery or conservative limited resection in Crohn’s disease: study protocol for an international, multicenter, randomized controlled trial. Trials. 2020;21(1):210. DOI: 10.1186/s13063-020-4105-x
6. Golovenko O.V., Khomeriki S.G., Ivanova E.V., Fedorov E.D., Loranskaya I.D., Sitkin S.I., et al. Inflammatory bowel disease. Clinical, endoscopic, morphological aspects of diagnosis. Principles of modern therapy. Moscow: Prima Print; 2022 (In Russ.).
7. Luglio G., Rispo A., Imperatore N., Giglio M.C., Amendola A., Tropeano F.P., et al. Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn’s disease: The SuPREMe-CD Study — a randomized clinical trial. Ann Surg. 2020;272(2):2107. DOI: 10.1097/SLA.0000000000003821
8. Greuther T., Piller A., Fournier N., Safroneva E., Straumann A., Biedermann L., et al. Upper gastrointestinal involvement in Crohn’s disease: incidence, risk factors and course of the disease. J Crohn’s Colitis. 2018;12(12):1399409. DOI: 10.1093/ecco-jcc/jjy121
9. Desreumaux P., Ernst O., Geboes K., Gambiez L., Berrebi D., MüllerAlouf H., et al. Inflammatory alterations in mesenteric adipose tissue in Crohn’s disease. Gastroenterology. 1999;117(1):73–81. DOI: 10.1016/s0016-5085(99)70552-4
10. Zhang X., Ko H.M., Torres J., Panchal H.J., Cai Z., Wagner M., et al. Luminally polarized mural and vascular remodeling in ileal strictures of Crohn’s disease. Hum Pathol. 2018;79:42–9. DOI: 10.1016/j.humpath.2018.03.004
11. Alfredsson J., Wick M.J. Mechanism of fibrosis and stricture formation in Crohn’s disease. Scand J Immunol. 2020;92(6):e12990. DOI: 10.1111/sji.12990
12. Scheibe K., Kersten C., Schmied A., Vieth M., Primbs T., Carlé B., et al. Inhibiting interleukin 36 receptor signaling reduces fibrosis in mice with chronic intestinal inflammation. Gastroenterology. 2019;156(4):108297.e11. DOI: 10.1053/j.gastro.2018.11.029
13. Chen W., Lu C., Hirota C., Iacucci M., Ghosh S., Gui X. Smooth muscle hyperplasia/hypertrophy is the most prominent histological change in Crohn’s fibrostenosing bowel strictures: a semiquantitative analysis by using a novel histological grading scheme. J Crohns Colitis. 2017;11(1):92 - 104. DOI: 10.1093/ecco-jcc/jjw126
14. Yin Y., Zhu Z.X., Li Z., Chen Y.S., Zhu W.M. Role of mesenteric component in Crohn’s disease: A friend or foe? World J Gastrointest Surg. 2021;13(12):153649. DOI: 10.4240/wjgs.v13.i12.1536
15. Rivera E.D., Coffey J.C., Walsh D., Ehrenpreis E.D. The mesentery, systemic inflammation, and Crohn’s disease. Inflamm Bowel Dis. 2019;25(2):226 - 34. DOI: 10.1093/ibd/izy201
16. Crohn B.B., Ginzburg L., Oppenheimer G.D. Regional ileitis: a pathologic and clinical entity. JAMA. 1932;99(16):1323 - 9. DOI: 10.1001/jama.1932.02740680019005
17. Sheehan A.L., Warren B.F., Gear M.W., Shepherd N.A. Fat-wrapping in Crohn’s disease: pathological basis and relevance to surgical practice. Br J Surg. 1992;79(9):955–8. DOI: 10.1002/bjs.1800790934
18. Sleiman J., Chirra P., Gandhi N.S., Baker M.E., Lu C., Gordon I.O., et al. Crohn’s disease related strictures in cross-sectional imaging: More than meets the eye? United European Gastroenterol J. 2022;10(10):1167 - 78. DOI: 10.1002/ueg2.12326
19. Zhong Y.K., Lu B.L., Huang S.Y., Chen Y.J., Li Z.P., Rimola J., et al. Cross-sectional imaging for assessing intestinal fibrosis in Crohn’s disease. J Dig Dis. 2020;21(6):34250. DOI: 10.1111/1751-2980.12881
20. Demidova A.A., Danilov M.A., Leont’yev A.V., Abdulatipova Z.M., Saakyan G.G. Extended resection of mesentery in Crohn’s disease (review). Science of the Young (Eruditio Juvenium). 2022;10(2):21324 (In Russ.). DOI: 10.23888/HMJ2022102213-224
21. Seastedt K.P., Trencheva K., Michelassi F., Alsaleh D., Milsom J.W., Sonoda T., et al. Accuracy of CT enterography and magnetic resonance enterography imaging to detect lesions preoperatively in patients undergoing surgery for Crohn’s disease. Dis Colon Rectum. 2014;57(12):1364–70. DOI: 10.1097/DCR.0000000000000244
22. Pous-Serrano S., Frasson M., Palasí Giménez R., Sanchez-Jordá G., Pamies-Guilabert J., Llavador Ros M., et al. Accuracy of magnetic resonance enterography in the preoperative assessment of patients with Crohn’s disease of the small bowel. Colorectal Dis. 2017;19(5):O126–33. DOI: 10.1111/codi.13613
23. Taylor S.A., Mallett S., Bhatnagar G., Morris S., Quinn L., Tomini F., et al. Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study. Health Technol Assess. 2019;23(42):1–162. DOI: 10.3310/hta23420
24. Rieder F., Zimmermann E.M., Remzi F.H., Sandborn W.J. Crohn’s disease complicated by strictures: a systematic review. Gut. 2013;62(7):1072–84. DOI: 10.1136/gutjnl-2012-304353
25. Bettenworth D., Gustavsson A., Atreja A., Lopez R., Tysk C., van Assche G., et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn’s disease. Inflamm Bowel Dis. 2017;23(1):133 - 42. DOI: 10.1097/MIB.0000000000000988
26. Taida T., Nakagawa T., Ohta Y., Hamanaka S., Okimoto K., Saito K., et al. Long-term outcome of endoscopic balloon dilatation for strictures in patients with Crohn’s disease. Digestion. 2018;98(1):26–32. DOI: 10.1159/000486591
27. Lu C., Holubar S.D., Rieder F. How I approach the management of stricturing Crohn’s disease. Am J Gastroenterol. 2019;114(8):1181 - 4. DOI: 10.14309/ajg.0000000000000199
28. Lan N., Shen B. Endoscopic stricturotomy with needle knife in the treatment of strictures from inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(4):50213. DOI: 10.1097/MIB.0000000000001044
29. Navaneethan U., Lourdusamy D. Endoscopic stricturotomy and strictureplasty. Gastrointest Endosc Clin N Am. 2022;32(4):687 - 97. DOI: 10.1016/j.giec.2022.05.002
30. Aratari A., Papi C., Leandro G., Viscido A., Capurso L., Caprilli R. Early versus late surgery for ileo-caecal Crohn’s disease. Aliment Pharmacol Ther. 2007;26(10):1303–12. DOI: 10.1111/j.1365-2036.2007.03515.x
31. Latella G., Cocco A., Angelucci E., Viscido A., Bacci S., Necozione S., et al. Clinical course of Crohn’s disease first diagnosed at surgery for acute abdomen. Dig Liver Dis. 2009;41(4):269–76. DOI: 10.1016/j.dld.2008.09.010
32. Golovics P.A., Lakatos L., Nagy A., Pandur T., Szita I., Balogh M., et al. Is early limited surgery associated with a more benign disease course in Crohn’s disease? World J Gastroenterol. 2013;19(43):7701–10. DOI: 10.3748/wjg.v19.i43.7701
33. Fousekis F.S., Mitselos I.V., Tepelenis K., Pappas-Gogos G., Katsanos K.H., Lianos G.D., et al. Medical, endoscopic and surgical management of stricturing Crohn’s disease: current clinical practice. J Clin Med. 2022;11(9):2366. DOI: 10.3390/jcm11092366
34. Chandrasinghe P. Surgical management of small bowel Crohn’s disease. Front Surg. 2022;9:759668. DOI: 10.3389/fsurg.2022.759668
35. Bemelman W.A., Warusavitarne J., Sampietro G.M., Serclova Z., Zmora O., Luglio G., et al. ECCO-ESCP Consensus on surgery for Crohn’s disease. J Crohns Colitis. 2018;12(1):1–16. DOI: 10.1093/ecco-jcc/jjx061
36. Simillis C., Purkayastha S., Yamamoto T., Strong S.A., Darzi A.W., Tekkis P.P. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum. 2007;50(10):1674–87. DOI: 10.1007/s10350-007-9011-8
37. Guo Z., Li Y., Zhu W., Gong J., Li N., Li J. Comparing outcomes between side-to-side anastomosis and other anastomotic configurations after intestinal resection for patients with Crohn’s disease: a meta-analysis. World J Surg. 2013;37(4):893–901. DOI: 10.1007/s00268-013-1928-6
38. Sehgal R., Coffey J.C. Historical development of mesenteric anatomy provides a universally applicable anatomic paradigm for complete/total mesocolic excision. Gastroenterol Rep (Oxf). 2014;2(4):245–50. DOI: 10.1093/gastro/gou046
39. Culligan K., Walsh S., Dunne C., Walsh M., Ryan S., Quondamatteo F., et al. The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg. 2014;260(6):1048–56. DOI: 10.1097/SLA.0000000000000323
40. Landerholm K., Reali C., Mortensen N.J., Travis S.P.L., Guy R.J., George B.D. Short- and long-term outcomes of strictureplasty for obstructive Crohn’s disease. Colorectal Dis. 2020;22(9):115968. DOI: 10.1111/codi.15013
41. Coffey C.J., Kiernan M.G., Sahebally S.M., Jarrar A., Burke J.P., Kiely P.A., et al. Inclusion of the mesentery in ileocolic resection for Crohn’s disease is associated with reduced surgical recurrence. J Crohns Colitis. 2018;12(10):1139 - 50. DOI: 10.1093/ecco-jcc/jjx187
42. Luglio G., Kono T. Surgical techniques and risk of postoperative recurrence in CD: a game changer. Inflamm Intest Dis. 2021;7(1):217. DOI: 10.1159/000515372
43. Peltrini R., Greco P.A., Manfreda A., Luglio G., Bucci L. Kono-S anastomosis after intestinal resection for Crohn’s disease. Updates Surg. 2020;72(2):33540. DOI: 10.1007/s13304-019-00700-w
Review
For citations:
Aitova L.R., Grishina E.E., Sakaev E.M., Shchekin V.S. Stricturing Small Bowel Crohn’s Disease (Literature Review). Creative surgery and oncology. 2024;14(1):52-59. (In Russ.) https://doi.org/10.24060/2076-3093-2024-14-1-52-59
Views:
2033
Email this article 