Endoscopic Management of Strictures in Crohn's Disease: An Unsolved Case

Abstract

Crohn's disease (CD) is a chronic inflammatory disease associated with a significant burden in terms of quality of life and health care costs. It is frequently associated with several complications, including the development of intestinal strictures. Stricturing CD requires a careful multidisciplinary approach involving medical therapy and surgery, still posing a continuous management challenge; in this context, endoscopic treatment represents a valuable, in-between opportunity as a minimally invasive strategy endorsed by extensive yet heterogeneous evidence and evolving research and techniques. This review summarizes current knowledge on the role of therapeutic endoscopy in stricturing CD, focusing on evidence gaps, recent updates, and novel techniques intended for optimizing efficacy, safety, and tailoring of this approach in the view of precision endoscopy.

Keywords: Crohn; Crohn’s disease; EBD; balloon dilation; fibrosis; intestinal stent; nanoparticles; stricture; stricturotomy.

Figure 1

Evolution of endoscopy in stricturing Crohn’s Disease. The improvement of the known techniques alongside with the development of new technologies paves the way for an increasingly less invasive, combined endoscopic approach, with a view to tailored management, bowel-sparing strategy, and better quality of life.

Figure 2

Endoscopic management of strictures in Crohn’s Disease based on the practice guidelines on endoscopic treatment for Crohn’s disease strictures [9]. CD, Crohn’s Disease; EBD, endoscopic balloon dilation. * No adjacent fistulae or abscesses; ** technical success in defined as post-procedural resistance-free passage of the endoscope through the stricture; *** only in centers with specific expertise.