Biopsy under direct vision for the diagnosis of Crohn's disease.

WATANABE, H., HIWATASHI, N. and GOTO, Y. Biopsy under Direct Vision for the Diagnosis of Crohn's Disease. Tohoku J. exp. Med., 1979, 129 (1), 1-8-In order to clarify the role of biopsy in distinguishing Crohn's disease from intestinal tuberculosis before surgery, the histologic findings of the biopsy specimens from 8 cases of Crohn's disease were investigated in comparison with those from 19 cases of intestinal tuberculosis. The samples were obtained under direct vision through a fibercolonoscope from areas showing a cobblestone appearance or narrowing, and then approximately 60 serial sections of each sample were prepared whenever Crohn's disease was suspected on the basis of x-ray and endoscopic findings and clinical features. As a result, characteristic histologic findings such as small and discrete mucosal, noncaseating granulomas, disproportional inflammation, discontinuity of the lesion, and submucosal neuromatous hyperplasia were found in the majority of Crohn's disease cases. Granulomas were also found frequently in the cases of intestinal tuberculosis, although other findings were rare in such cases. Among granulomas in the intestinal tuberculosis cases, the number of submucosal granulomas was large and they showed a tendency to confluence, but the granulomas in the mucosa were small and discrete, as was the cases in the granulomas in Crohn's disease. There were no cases of caseating granulomas in the intestinal tuberculosis cases and the results of cultures for tubercle bacilli from biopsied samples were negative in the majority of cases in which cultures were attempted. Accordingly, it is thought to be difficult to differentiate Crohn's disease correctly from intestinal tuberculosis on biopsy alone, although biopsy under direct vision itself is a useful diagnostic procedure in Crohn's disease. Crohn's disease; intestinal tuberculosis; fibercolonoscope