Endoscopic Features of Crohns Disease

Morphologic pictures observed during an endoscopic procedure are protean. The earliest endoscopic finding is the aphthous ulcer with a diameter of a few millimeters surrounded by a thin red halo of oede-matous tissue [2], which is found in about 30-40% of patients with Crohn's colitis. Focal oedema and sporadic red spots are present in the "preaphthoid phase [3]. These lesions usually are multiple, becoming stellate or linear in shape, with normal intervening mucosa, and can be rounded or long and serpigi-nous. Cobblestone-like areas are formed when ulcers assume a longitudinal and transverse pattern forming a grid. This is due to submucosal oedema, including nonulcerated mucosa [4]. Sometimes, these lesions differ little from inflammatory polyps or pseudopolyps also often present in Crohn's colitis [5]. The presence of punched-out ulcers adjacent to inflamed mucosa gives rise after healing to mucosal bridges. Stenosis is often present in areas of severe inflammation, especially in the pyloric sphincter, ileocecal valve and rectosigmoid junction [6]. Length may vary from less than 3 cm to more than 10 cm and a width of less of 5 mm. Fistulae have been reported in more than 8% of patients affected by Crohn's colitis, often near stenoses [7]. Less common manifesta tions are diffuse mucosal irregularities with erythema, oedema, granularity.

Carrying out multiple biopsies in areas both involved and uninvolved by the disease increases diagnostic accuracy of endoscopy and pathology. The use of large biopsy forceps should be taken in consideration for obtaining a better specimen of the submucosa [8]. Finally, during colonoscopy, it is mandatory that intubation of the terminal ileum is performed in order to take biopsies that may increase the procedure's sensitivity and specificity [9].

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