Exabis Library

The isoperistaltic side-to side strictureplasty over the valve provdes a means to avoid ileocaecal resection in patients with stricturing terminal ieal disease.  Indications are a long segment of diseased terminal ileum (> 35 cm) or multiple adjacent strictures over a long length of bowel.
The technque has shown teo be safe with acceptable septic complications.  To imrove long-term outcome a broad inlet to the strictureplasty should be created (Sasaka modification).  About 1 in 4 patients will develop a deep remission and do not need further medical treatment.  The stricutreplasty can be monitored with flexible endoscopy.  A proximal to distal healing has been observed and a remoddeling of the bowel wall occurs (transsectional imaging). On the long-term efficacy equals the outcome of resection especially in an era of thight disease follow-up.  A surgical resection rate of 16% at 5 yrs has been noted.  The need to resect the stricutreplasty was extremely limied.
Despite those findings the complexity of the procedure hampers widespread implementation.

This course is designed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). One major aim of this e-learning activity is to increase competence and knowledge with regard to the prediction, diagnosis and management of stricturing Crohn's Disease (CD) patients and to harmonise diagnostics and treatment in order to improve patient outcomes.

Upon completion of this activity learners will:

• Achieve familiarity with predictors of fibrostenosing CD.

• Understand the role of cross-sectional imaging in the diagnostic work-up of patients with suspected fibrostenosing CD.
• Understand the current management of fibrostenosing CD.
• Recognise the therapeutic capabilities of anti-inflammatory therapy, endoscopic dilatation and surgery in the setting of fibrostenosing CD.

To understand the value of pathology in reporting/documentation of the course of IBD diseases
To understand the value of pathology in guiding surgical treatment of Crohn and ulcerative colitis

Data on the outcomes of surgery due to IBD in pregnant patients is scarce, and primarily dates back more than 3 decades ago. Primary aim: to evaluate the evolution of pregnancies and offspring after surgery due to IBD. Secondary aims: to describe the indications for surgery, the surgical techniques used, and the frequency of caesarean section concomitant to surgery for IBD

SCAR is a retrospective, multicenter study approved by ECCO COllaborative Network For Exceptionally Rare Case Reports (CONFER). Patients operated on due to IBD during pregnancy after 1998 (first biologic agent approved) were included. Data on patients’ demographics, IBD characteristics, medical treatments, IBD activity, pregnancy outcomes, surgery, delivery, foetal and maternal outcomes, were recorded

44 IBD patients were included (figure 1),

all singleton pregnancies. Seven patients (16%) were diagnosed with IBD during pregnancy, 75% had Crohn’s disease (51% fistulizing behavior), and 23% had ulcerative colitis. 34% had previously undergone surgery due to IBD. Several complementary examinations were performed during pregnancy without complications (figure 2)
Patients were being administered the following medications: corticosteroids (61%), biologicals (57%), thiopurines (23%) with 20% being on biologics and thiopurines. 93% of surgeries were performed in University hospitals, (2^nd Trimester: 55%; 3^rd trimester: 27%) with 77% of them being urgent surgeries (figure 3)
One patient had hemoperitoneum during surgery, and 27% had postsurgical complications. No woman died. 62.5% of deliveries were induced (figure 4),
70% of them by C-section, with 51% of mothers having a prolonged hospitalization. There were 40 newborns alive and 4 miscarriages/stillbirths (1 in the 1^st, 2 in the 2^nd, and 1 in the 3^rd trimester): 2 occurred during surgery and 2 occurred 2 weeks after surgery. 14% of the surgeries during the 2^nd trimester and 64% of those in the 3^rd trimester ended up with a simultaneous C-section or delivery.  Of the 40 newborns alive, there were 9 healthy (24%), 61% premature, and 47% with low birth weight. A total of 42% of newborns needed hospitalization (25% in the intensive care unit, mainly due to respiratory distress)

The need for surgery for IBD during pregnancy remains an extremely serious situation. Maternal and foetal mortality are lower than previously described, most likely due to better supporting care. However, even in the current years, 30% of the mothers and 80% of newborns have complications, and 25% of the offspring need admission to the intensive care unit. Therefore, surgical management should be performed by a multidisciplinary team, involving gastroenterologists, colorectal surgeons, obstetricians and neonatal specialists.

1. To define the appropriate timing between medical and surgical management of IBD
2. To review medical and surgical treatment indications of the complications of IBD  
3. To learn how to decide in multidisciplinary team between the two modalities of treatment