Ileoscopy via Stoma After Diverting Ileostomy: A Safe and Effective Tool to Evaluate for Crohn's Recurrence of Neoterminal Ileum.
Summary of "Ileoscopy via Stoma After Diverting Ileostomy: A Safe and Effective Tool to Evaluate for Crohn's Recurrence of Neoterminal Ileum."
BACKGROUND:
Recurrence of Crohn's disease (CD) most commonly occurs in the neoterminal ileum near the stoma after fecal diverting ileostomy. Methods used to assess CD recurrence include small bowel series, ileostomy injection, computed tomography (CT) enterography, and capsule endoscopy. Retrograde ileoscopy via stoma is also a valuable tool for recognition of CD recurrence; however, this technique has not been formally studied.
OBJECTIVE:
To evaluate the safety and utility of retrograde ileoscopy via stoma in patients with CD.
METHODS:
Patients with CD who underwent ileoscopy via stoma between January 1, 2001, through December 31, 2008 were included. This was a retrospective study in a tertiary referral center. The main outcome measures were procedural complications and findings.
RESULTS:
A total of 243 ileoscopies were performed on 99 patients. The most common indications for ileoscopy were CD activity assessment in 34.5% and abdominal pain in 33.3%. The procedure was outpatient in 75.8%. Meperidine and midazolam were most commonly used. Average depth of intubation was 28.4 cm. CD recurrence was detected in 70% of patients. Biopsies were obtained during ileoscopy in 117 studies, and biopsy and ileoscopy findings correlated in 111 studies (94.8%). One polypectomy, 24 balloon stricture dilations, and 8 intralesional steroid injections were performed. All patients tolerated the procedure well without procedure- or anesthesia-related complications. No hospital admissions or procedure-related deaths occurred.
CONCLUSIONS:
Retrograde ileoscopy via stoma is a safe and effective procedure for evaluating recurrence of CD of the neoterminal ileum. It also allows for therapeutic interventions such as balloon dilatation of ileal strictures and steroid injections.
Affiliation
Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Journal Details
This article was published in the following journal.
Name: Digestive diseases and sciences
ISSN: 1573-2568
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20635144
- DOI: http://dx.doi.org/10.1007/s10620-010-1332-0
Medical and Biotech [MESH] Definitions
Ceftizoxime
A semisynthetic cephalosporin antibiotic which can be administered intravenously or by suppository. The drug is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative organisms. It has few side effects and is reported to be safe and effective in aged patients and in patients with hematologic disorders.
Pest Control, Biological
The use of biological mechanisms, usually involving living organisms such as bacteria, for the reduction or regulation of the population of noxious, destructive, or dangerous pests. Environmental concerns have focused attention on natural forms of disease control as potentially safe and effective alternatives to chemical pesticides. This has led to increased efforts to develop control strategies that rely on natural predators and parasites or that involve genetically engineered microbial pest control agents.
Tool Use Behavior
Modifying, carrying, or manipulating an item external to itself by an animal, before using it to effect a change on the environment or itself (from Beck, Animal Tool Behavior, 1980).
Esophagostomy
Surgical formation of an external opening (stoma) into the esophagus.
No-observed-adverse-effect Level
The highest dosage administered that does not produce toxic effects. The NOAEL will depend on how closely dosages are spaced (lowest-observed-adverse-effect level and no-observed-effect level) and the number of animals examined. The ultimate objective is usually to determine not the "safe" dosage in laboratory animals but the "safe" dosage for humans. Therefore, the extrapolation most often required of toxicologists is from high-dosage studies in laboratory animals to low doses in humans. (Casarett and Doull's Toxicology: The Basic Science of Poisons, 4th ed)
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