Intest Res.  2020 Jan;18(1):1-10. 10.5217/ir.2019.09158.

Update of endoscopic management of Crohn’s disease strictures

• Pokala A
• Shen B

• KMID: 2501362
• DOI: http://doi.org/10.5217/ir.2019.09158

Abstract

One of the most common complications of Crohn’s disease (CD) is the formation of strictures. Endoscopy plays a vital role not only in the diagnosis, differential diagnosis, and disease monitoring of CD, but also the delivery of effective treatment. The purpose of this review is to update the endoscopic management of strictures in CD. Endoscopic therapy has provided minimally invasive treatment for CD. Commonly used endoscopic treatment modalities include balloon dilation, endoscopic stricturotomy, endoscopic strictureplasty, and endoscopic stenting. The pros and cons of these endoscopic treatment modalities are discussed.

Keyword

Crohn disease; Endoscopy; Therapy

Figure

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  Fig. 1. Antegrade endoscopic balloon dilation of an ileocolonic anastomosis stricture in CD. (A) The tight, nonulcerated stricture at the anastomosis. (B, C) Balloon dilation of the stricture prior to the passage of the scope. (D) Post-dilation appearance of the stricture with some bleeding.

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  Fig. 2. Retrograde endoscopic balloon dilation of an ileocecal valve stricture in CD. (A) The nonulcerated stricture at the ileocecal valve which was traversable to a pediatric colonoscope. (B, C) Passage of endoscope through the stricture and advancement of balloon sheath. (D) Withdrawal of the scope along with advanced balloon sheath and subsequent insufflation of the balloon.

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  Fig. 3. Endoscopic stricturotomy of a long anorectal stricture in CD. (A) The 6-cm long tight ulcerated stricture resulting from the disease and previous repeated endoscopic balloon and bougie dilations. (B) Stricturotomy with a needle knife. (C) Stricturotomy with an insulated-tip knife. (D) Posttreatment appearance of the stricture.

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  Fig. 4. Endoscopic strictureplasty of an ileocolonic anastomotic stricture in CD. (A) The short, ulcerated stricture with dislodged staples at the anastomosis. (B, C) Endoscopic electroincision with a needle knife. (D) Placement of endoclips to the incised stricture as spacers.

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  Fig. 5. Endoscopic stenting of a short ileocolonic anastomotic stricture in CD. (A) The tight, short anastomosis stricture. (B-D) Placement of a 22×10 mm lumen-opposing metal stent.

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