Abstract
Symptomatic intestinal strictures develop in more than one third of patients with Crohn’s disease during their lifetime. Strictures can be inflammatory, fibrotic or mixed. Fibrosis occurs as a result of excessive deposition of extracellular matrix protein. It can lead to severe symptoms affecting patients’ quality of life. As a result, patients will often need to undergo surgery to improve their symptoms. Endoscopic balloon dilatation appears to be a safe and effective alternative therapeutic procedure to replace or postpone surgery. It is less invasive and can be performed during a regular colonoscopy. Non-complex strictures that are ≤5 cm can be dilated endoscopically. Up to 80% of patients will have immediate relief of symptoms and it can prevent surgery in up to 70% of patients after a 3-year follow up. Serious complications are rare and occur in less than 3% of procedures.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Latella G, Papi C. Crucial steps in the natural history of inflammatory bowel disease. World J Gastroenterol. 2012;18(29):3790–9.
Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8(4):244–50.
Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut. 2001;49(6):777–82.
Munkholm P, Langholz E, Davidsen M, Binder V. Disease activity courses in a regional cohort of Crohn’s disease patients. Scand J Gastroenterol. 1995;30(7):699–706.
Papi C, Festa V, Fagnani C, Stazi A, Antonelli G, Moretti A, et al. Evolution of clinical behaviour in Crohn’s disease: predictive factors of penetrating complications. Dig Liver Dis. 2005;37(4):247–53.
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785–94.
Oberhuber G, Stangl PC, Vogelsang H, Schober E, Herbst F, Gasche C. Significant association of strictures and internal fistula formation in Crohn’s disease. Virchows Arch. 2000;437(3):293–7.
Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: a systematic review. Gut. 2013;62(7):1072–84.
Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology. 1990;99(4):956–63.
Fiocchi C, Lund PK. Themes in fibrosis and gastrointestinal inflammation. Am J Physiol Gastrointest Liver Physiol. 2011;300(5):G677–83.
Graham MF, Diegelmann RF, Elson CO, Lindblad WJ, Gotschalk N, Gay S, et al. Collagen content and types in the intestinal strictures of Crohn’s disease. Gastroenterology. 1988;94(2):257–65.
Cosnes J, Nion-Larmurier I, Beaugerie L, Afchain P, Tiret E, Gendre JP. Impact of the increasing use of immunosuppressants in Crohn’s disease on the need for intestinal surgery. Gut. 2005;54(2):237–41.
Faubion WA Jr, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121(2):255–60.
Spinelli A, Correale C, Szabo H, Montorsi M. Intestinal fibrosis in Crohn’s disease: medical treatment or surgery? Curr Drug Targets. 2010;11(2):242–8.
Van Assche G, Geboes K, Rutgeerts P. Medical therapy for Crohn’s disease strictures. Inflamm Bowel Dis. 2004;10(1):55–60.
Vermeire S, Noman M, Van Assche G, Baert F, D’Haens G, Rutgeerts P. Effectiveness of concomitant immunosuppressive therapy in suppressing the formation of antibodies to infliximab in Crohn’s disease. Gut. 2007;56(9):1226–31.
Bettenworth D, Rieder F. Medical therapy of stricturing Crohn’s disease: what the gut can learn from other organs—a systematic review. Fibrogenesis Tissue Repair. 2014;7(1):5.
Shivananda S, Hordijk ML, Pena AS, Mayberry JF. Crohn’s disease: risk of recurrence and reoperation in a defined population. Gut. 1989;30(7):990–5.
Saunders BP, Brown GJ, Lemann M, Rutgeerts P. Balloon dilation of ileocolonic strictures in Crohn’s disease. Endoscopy. 2004;36(11):1001–7.
Despott EJ, Gupta A, Burling D, Tripoli E, Konieczko K, Hart A, et al. Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn’s disease (with video). Gastrointest Endosc. 2009;70(5):1030–6.
Karstensen JG, Hendel J, Vilmann P. Endoscopic balloon dilatation for Crohn’s strictures of the gastrointestinal tract is feasible. Dan Med J. 2012;59(7):A4471.
Neufeld DM, Shemesh EI, Kodner IJ, Shatz BA. Endoscopic management of anastomotic colon strictures with electrocautery and balloon dilation. Gastrointest Endosc. 1987;33(1):24–6.
Bettenworth D, Gustavsson A, Atreja A, Lopez R, Tysk C, van Assche G, et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing Crohn's disease. Inflamm Bowel Dis. 2017;23(1):133–42.
Hassan C, Zullo A, De Francesco V, Ierardi E, Giustini M, Pitidis A, et al. Systematic review: endoscopic dilatation in Crohn’s disease. Aliment Pharmacol Ther. 2007;26(11-12):1457–64.
Lian L, Stocchi L, Remzi FH, Shen B. Comparison of endoscopic dilation vs surgery for anastomotic stricture in patients with Crohn’s disease following ileocolonic resection. Clin Gastroenterol Hepatol. 2017;15(8):1226–31.
Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P. Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn’s strictures: a prospective longterm analysis. Gut. 1995;36(4):577–80.
Hoffmann JC, Heller F, Faiss S, von Lampe B, Kroesen AJ, Wahnschaffe U, et al. Through the endoscope balloon dilation of ileocolonic strictures: prognostic factors, complications, and effectiveness. Int J Color Dis. 2008;23(7):689–96.
Scimeca D, Mocciaro F, Cottone M, Montalbano LM, D'Amico G, Olivo M, et al. Efficacy and safety of endoscopic balloon dilation of symptomatic intestinal Crohn’s disease strictures. Dig Liver Dis. 2011;43(2):121–5.
Thienpont C, D’Hoore A, Vermeire S, Demedts I, Bisschops R, Coremans G, et al. Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut. 2010;59(3):320–4.
Solem CA, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Small intestinal adenocarcinoma in Crohn’s disease: a case-control study. Inflamm Bowel Dis. 2004;10(1):32–5.
Rieder F, Latella G, Magro F, Yuksel ES, Higgins PD, Di Sabatino A, et al. European Crohn’s and colitis organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn’s disease. J Crohns Colitis. 2016;10(8):873–85.
Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endosc. 2002;56(6):829–34.
Kochhar R, Poornachandra KS. Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc. 2010;2(2):61–8.
Nelson RS, Hernandez AJ, Goldstein HM, Saca A. Treatment of irradiation esophagitis. Value of hydrocortisone injection. Am J Gastroenterol. 1979;71(1):17–23.
Ramage JI Jr, Rumalla A, Baron TH, Pochron NL, Zinsmeister AR, Murray JA, et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol. 2005;100(11):2419–25.
Roques C, Teot L. The use of corticosteroids to treat keloids: a review. Int J Low Extrem Wounds. 2008;7(3):137–45.
Di Nardo G, Oliva S, Passariello M, Pallotta N, Civitelli F, Frediani S, et al. Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn’s disease with stricture: a prospective, randomized, double-blind, controlled trial. Gastrointest Endosc. 2010;72(6):1201–8.
East JE, Brooker JC, Rutter MD, Saunders BP. A pilot study of intrastricture steroid versus placebo injection after balloon dilatation of Crohn’s strictures. Clin Gastroenterol Hepatol. 2007;5(9):1065–9.
Sorrentino D, Avellini C, Beltrami CA, Pasqual E, Zearo E. Selective effect of infliximab on the inflammatory component of a colonic stricture in Crohn’s disease. Int J Color Dis. 2006;21(3):276–81.
Swaminath A, Lichtiger S. Dilation of colonic strictures by intralesional injection of infliximab in patients with Crohn’s colitis. Inflamm Bowel Dis. 2008;14(2):213–6.
ASGE Technology Committee, Siddiqui UD, Banerjee S, Barth B, Chauhan SS, Gottlieb KT, et al. Tools for endoscopic stricture dilation. Gastrointest Endosc. 2013;78(3):391–404.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Bessissow, T., Van Assche, G. (2018). Endoscopic Therapy of Intestinal Strictures: What Is State of the Art?. In: Rieder, F. (eds) Fibrostenotic Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-90578-5_16
Download citation
DOI: https://doi.org/10.1007/978-3-319-90578-5_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90577-8
Online ISBN: 978-3-319-90578-5
eBook Packages: MedicineMedicine (R0)