Endoscopic management of intestinal strictures in Crohn’s disease: Current status and future perspectives

Table 2 Categorization of Crohn’s disease strictures

Category	Subtypes	Examples/clinical relevance
Source/etiology	Intrinsic	Intrinsic: Most CD strictures (inflammation/fibrosis), anastomotic/postoperative strictures, malignant CD strictures. Extrinsic: Adhesions, compression by abscess/phlegmon
	Extrinsic
Clinical presentation	Symptomatic	Guides the urgency of intervention
	Asymptomatic
Underlying disease/process	Primary (CD related)	Important for management strategy
	Secondary [post-surgical (including stoma site stricture)]
Malignant potential	Benign	Critical to rule out before endoscopic therapy, especially in long-standing colonic disease
	Malignant
Inflammation vs fibrosis	Inflammatory	Influences response to medical vs endoscopic therapy
	Fibrotic
	Mixed
Length	Short (< 4-5 cm)	Short → better for endoscopic therapy (EBD/ESt)
	Long (≥ 4-5 cm)
Number	Single	Multiple → higher complexity
	Multiple
Severity/degree	Mild	Mild/moderate-allows passage of scope with mild/moderate resistance, respectively. Severe- pinhole stricture, not traversable to scope
	Moderate
	Severe
Morphology/stricture characteristics	Web/ulcerated/spindle-shaped/angulated, symmetrical/asymmetrical	Influences technical feasibility and risk of perforation during intervention
Complexity	Simple	Complex strictures are typically long, angulated, multiple, associated with fistulae, abscess, deep ulcerations, or marked pre-stenotic dilatation
	Complex
Location	Esophagus, pylorus, small bowel, IC valve, colon, rectum, anus	Determines endoscopic approach and feasibility

CD: Crohn’s disease; EBD: Endoscopic balloon dilation; ESt: Endoscopic stricturotomy; IC: Ileo-caecal.