Endoscopic Stricturotomy and Strictureplasty

Abstract

Strictures in inflammatory bowel disease (IBD) usually occur because of long-standing inflammation and fibrosis causing luminal narrowing. Strictures in the setting of Crohn's disease (CD) can occur de novo, or in the postsurgical setting (anastomotic strictures). Historically these strictures are managed with invasive surgical procedures which may result in considerable morbidity. Endoscopic interventions for IBD complications have evolved significantly in the last decade providing a minimally invasive option. Endoscopic balloon dilation is the commonly performed technique for CD strictures. Endoscopic stricturotomy and strictureplasty are relatively novel techniques for the management of CD strictures that can achieve comparable efficacy to surgery albeit with fewer complications and a low rate of surgical interventions. Although immediate bleeding can be an adverse event as the strictures are directly targeted with precision, there is a lower rate of major adverse events including perforation. In this review, we will focus on endoscopic stricturotomy and strictureplasty in the management of strictures in CD.

Keywords: Crohn’s disease; Inflammatory bowel disease; Strictureplasty; Strictures; Stricturotomy.