Is there concordance between the Cellvizio system and pathology in determining microscopic inflammation at the ileal resection margins in Crohn's ileal disease? The CELLVICROHN study

Crohn's disease is an inflammatory bowel disease for which surgery is required in approximately 80% of cases. However, surgery does not cure Crohn's disease. The type of surgery is important, as there are intraoperative risk factors for recurrence, including microscopic inflammation at the resection margins. This point is crucial, as a too large resection may result in short bowel syndrome and a too short resection (microscopic inflammation at the resection site) a higher risk of postoperative recurrence (75% vs 46% at 18 months). Based on the results of a randomised control trial, surgeons are encouraged to perform a limited resection (2 cm from macroscopic Crohn's disease). However, such a macroscopically non-inflamed resection margin may show microscopic inflammation (up to 80%). Thus, it would be useful to evaluate whether there is microscopic inflammation at the resection margin. Moreover, there is an increasing interest in the role of the mesentery in recurrence, which is still unclear. Thus, it would be informative to also clarify the border between inflamed and non-inflamed mesentery. Cellvizio is a type of confocal laser endomicroscopy system that provides the possibility to obtain high-magnification in-vivo images of the gut epithelium. This allows real-time examination of the gastrointestinal mucosa at the cellular and subcellular level. Cellvizio has never been used during surgery for Crohn's disease.