Early vascular changes in Crohn's disease: an endoscopic fluorescence study.
BACKGROUND AND STUDY AIMS: Early recurrent lesions occurring after surgery in Crohn's disease may be the result of localized vasculitis. The aim of this study was use fluorescence endoscopy to evaluate the mucosal microcirculation of the neoterminal ileum in relation to endoscopic recurrence in patients who had undergone ileocolonic resection for Crohn's disease. PATIENTS AND METHODS: Ten patients were prospectively enrolled in an endoscopic follow-up study one year after surgery. Recurrence was assessed using routine and fluorescence endoscopy. Biopsies were taken from fluorescent and nonfluorescent sites to look for inflammation and mucosal vascular lesions using standard histological and immunohistochemical methods. RESULTS: Endoscopic recurrence was found in eight patients. At fluorescence endoscopy, the mucosa displayed a heterogeneous pattern, with fluorescent areas corresponding to aphthoid ulcerations; fluorescent rims surrounding dark zones, corresponding to stellar deep ulcers; and small bright spots distributed singly in the mucosa, which appeared normal on routine endoscopy. Histology revealed inflammatory changes with evidence of vascular involvement in 79% of the biopsies taken from the fluorescent spots. CONCLUSIONS: Endoscopic recurrence in Crohn's disease is associated with fluorescent aspects that may reflect vasodilation associated with inflammation, or genuine microvascular lesions. Correlation with the histological findings suggests that these early vascular lesions were secondary to the inflammatory process.