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World J Gastroenterol. May 7, 2018; 24(17): 1859-1867
Published online May 7, 2018. doi: 10.3748/wjg.v24.i17.1859
Endoscopic management of Crohn’s strictures
Talat Bessissow, Jason Reinglas, Achuthan Aruljothy, Peter L Lakatos, Gert Van Assche
Talat Bessissow, Jason Reinglas, Achuthan Aruljothy, Peter L Lakatos, Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, QC H3G1A4, Canada
Peter L Lakatos, 1st Department of Medicine, Semmelweis University, Budapest 1085, Hungary
Gert Van Assche, Division of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium and University of Leuven, Leuven 3000, Belgium
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting, critical revision, editing, and final approval of the final revision.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Talat Bessissow, MD, CM, FRCPC, Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, 1650 Cedar Avenue C7-200, Montreal, QC H3G1A4, Canada. talat.bessissow@mcgill.ca
Telephone: +1-514-9341934 Fax: +1-514-9348531
Received: March 10, 2018
Peer-review started: March 11, 2018
First decision: March 29, 2018
Revised: April 14, 2018
Accepted: April 23, 2018
Article in press: April 23, 2018
Published online: May 7, 2018
Abstract

Symptomatic intestinal strictures develop in more than one third of patients with Crohn’s disease (CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures. Treatment options for fibrostenotic strictures are limited to endoscopic and surgical therapy. Endoscopic balloon dilatation (EBD) appears to be a safe, less invasive and effective alternative modality to replace or defer surgery. Serious complications are rare and occur in less than 3% of procedures. For non-complex strictures without adjacent fistulizaation or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. The aim of this review is to present the current literature on the endoscopic management of small bowel and colonic strictures in CD, which includes balloon dilatation, adjuvant techniques of intralesional injection of steroids and anti-tumor necrosis factor, and metal stent insertion. Short and long-term outcomes, complications and safety of EBD will be discussed.

Keywords: Endoscopy, Crohn’s disease, Stricture, Stenosis, Inflammatory bowel disease, Endoscopic balloon dilation

Core tip: Endoscopic balloon dilation (EBD) for Crohn’s disease-related fibrostenotic strictures has been recognized as a safe, and less invasive intervention with rare complications that occur in less than 3% of procedures. EBD can replace or defer surgery and help avoid frequent intestinal resections, which result in short bowel syndrome and impair quality of life. For non-complex strictures without adjacent fistulization or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. In this review we discuss safety, short and long-term outcomes, as well as adjuvant techniques of intralesional injection of steroids, anti-tumor necrosis factor, and metal stent insertion.