Feasibility of intraoperative ultrasound of the small bowel during Crohn’s disease surgery

Abstract

Background Intraoperative assessment of the extent and location of Crohn's disease is not standardised and relies on a mixture of surgeons' experience, tactile feedback and macroscopic appearance. To overcome this variability, we developed a protocol for full intraoperative ultrasound scan of the small bowel and we here report the results of "Assessing the Feasibility and Safety of Using Intraoperative Ultrasound in Ileocolic Crohn's Disease-The IUSS CROHN Study". Methods This is a prospective single centre observational study with enrolment of all patients undergoing elective surgery for terminal ileal Crohn's disease from January 2019 to March 2020. Patients underwent laparoscopic ileocolic resection, according to a standardised technique. Ultrasound intraoperative quantitative assessment was performed according to the METRIC (MREnterography or ulTRasound in Crohn's disease) scoring guide. Results Intraoperative ultrasound was successfully performed in 6 patients from the ileocaecal valve to the proximal jejunum. The median time required was 23.5 min (range 17-37 min) as compared to 6.5 min (5-12 min) required for the macroscopic evaluation performed by the surgeon. In 3 patients, intraoperative ultrasound identified more disease than surgical evaluation. Conclusions This feasibility study demonstrated the safety of intraoperative ultrasound and allowed the development of a standardised protocol for intraoperative ultrasound and the data collection required to inform a randomised multicentre study.

Intraoperative Ultrasound in Colorectal Surgery

“…Intraoperative assessment needed to appreciate the extent and location of Crohn's disease has not been standardized and currently involves a mixture of surgeons' experience, tactile feedback, and macroscopic appearance. In a study titled "Assessing the Feasibility and Safety of Using Intraoperative Ultrasound in Ileocolic Crohn's Disease-The IUSS CROHN Study," Celentano and team [10] devised a strategy for a thorough intraoperative ultrasound scan of the small bowel to overcome this variability. This feasibility study mentioned above demonstrated the safety of intraoperative ultrasound and allowed the development of a standardized protocol for the intraoperative ultrasound.…”

ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology

“…Intraoperative ultrasonography has been shown to minimise intraoperative assessment variability; when used, technical details and findings should be added to the report. 88,89 A phlegmon can contain different bowel loops and structures. The description of the perioperative findings should explain the surgical strategy.…”