Endoscopic Management of Crohn’s Disease Strictures
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Mar 26, 2024
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Abstract
Crohn’s disease is a chronic, progressive inflammatory condition characterised by gastrointestinal tract inflammation and extra-intestinal manifestations.
Some patients may develop stricturing disease, which may either be of inflammatory, fibrotic or post-anastamotic aetiologies.
The management of fibrostenosis is challenging, necessitating preventative strategies and a multidisciplinary approach to its diagnosis and management once established. Although several treatment options are currently used in the management of strictures, there are currently no targeted anti-fibrotic therapies. Endoscopically, there are several modalities that can be employed in the symptomatic patient including balloon dilatation and stenting.
In this article we will briefly discuss the pathophysiology and investigations with focus centred around endoscopic management of Crohn’s strictures, before suggesting a strategy to employ when approaching these cases.
Keywords:
Crohn’s Disease, Endoscopic Management, Endoscopic Management of Crohn’s Disease Strictures
Article Details
How to Cite
SULIMAN, O. et al.
Endoscopic Management of Crohn’s Disease Strictures.
Medical Research Archives, [S.l.], v. 12, n. 3, mar. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5128>. Date accessed: 30 apr. 2024.
doi: https://doi.org/10.18103/mra.v12i3.5128.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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21. El Ouali S, Click B, Holubar SD, Rieder F. Natural history, diagnosis and treatment approach to fibrostenosing Crohn's disease. United European Gastroenterol J. 2020;8(3):2 63-270. doi:10.1177/2050640620901960. PM ID: 32213020
22. Bettenworth D, Gustavsson A, Atreja A, 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):133-142. doi:10.1097/MIB.0000000000000988
23. Thienpont C, D'Hoore A, Vermeire S, et al. Long-term outcome of endoscopic dilatation in patients with Crohn's disease is not affected by disease activity or medical therapy [published correction appears in Gut. 2010 Jul;59(7):1007]. Gut. 2010; 59(3):320-324. doi:10.1136/gut.2009.180182
24. Lu C, Baraty B, Lee Robertson H, et al. Systematic review: medical therapy for fibrostenosing Crohn's disease. Aliment Pharmacol Ther. 2020; 51(12):1233-1246. doi:10.1111/apt.15750
25. Attar A, Maunoury V, Vahedi K, et al. Safety and efficacy of extractible self-expandable metal stents in the treatment of Crohn's disease intestinal strictures: a prospective pilot study. Inflamm Bowel Dis. 2012;18(10):1849-1854. doi:10.1002/ibd.22844
26. Adamina M, Bonovas S, Raine T, et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment. Journal of Crohn’s and Colitis. 2019;14(2):155–168. doi:10.1093/ecco-jcc/jjz187
27. Levine RA, Wasvary H, Kadro O. Endoprosthetic management of refractory ileocolonic anastomotic strictures after resection for Crohn's disease: report of nine-year follow-up and review of the literature. Inflamm Bowel Dis. 2012; 18(3):506-512. doi: 10.1002/ibd.21739
28. Navaneethan U, Lourdusamy D. Endoscopic Stricturotomy and Strictureplasty. Gastrointest Endosc Clin N Am. 2022;32 (4):687-697. doi:10.1016/j.giec.2022.05.002
29. Shen B, Kochhar G, Navaneethan U, et al. Practical guidelines on endoscopic treatment for Crohn's disease strictures: a consensus statement from the Global Interventional Inflammatory Bowel Disease Group. Lancet Gastroenterol Hepatol. 2020;5(4):393-405. doi:10.1016/S2468-1253(19)30366-8
30. Lan N, Shen B. Endoscopic Stricturotomy Versus Balloon Dilation in the Treatment of Anastomotic Strictures in Crohn’s Disease. Inflamm Bowel Dis. 2018;24:897–907. doi:10. 1093/ibd/izx085.
2. 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):777-782. doi:10.1136/gut.49.6.777
3. Cosnes J, Cattan S, Blain A, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis. 2002;8(4):244-250. doi:10.1097/00054725-200207000-00002
4. Papi C, Festa V, Fagnani C, et al. Evolution of clinical behaviour in Crohn's disease: predictive factors of penetrating complications. Dig Liver Dis. 2005;37(4):247-253. doi:10.101 6/j.dld.2004.10.012
5. Rieder F, Fiocchi C, Rogler G. Mechanisms, management, and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology. 2017;152:340–50.
6. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn's disease complicated by strictures: a systematic review. Gut. 2013; 62(7):1072-1084. doi:10.1136/gutjnl-2012-304353
7. Rieder F, Latella G, Magro F, 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):873-885. doi:10.1093/ecco-jcc/jjw055
8. Solem CA, Loftus EV Jr, Fletcher JG, et al. Small-bowel imaging in Crohn's disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc. 2008;68(2):255-266. doi: 10.1016/j.gie.2008.02.017
9. Ismail MS, Charabaty A. Management of Crohn's stricture: medical, endoscopic and surgical therapies. Frontline Gastroenterol. 2022;13 (6):524-530. doi:10.1136/flgastro-2021-101827
10. Sleiman J, El Ouali S, Qazi T, et al. Prevention and Treatment of Stricturing Crohn's Disease - Perspectives and Challenges. Expert Rev Gastroenterol Hepatol. 2021;15(4):401-411. doi:10.1080/17 474124.2021.1854732. PMID: 33225766
11. Roda G, Chien Ng S, Kotze PG, et al. Crohn’s disease. Nat Rev Dis Primers. 2020; 6:22. PMID: 32242028.
12. Chen W, Lu C, Hirota C, Iacucci M, Ghosh S, Gui X. Smooth Muscle Hyperplasia/ Hypertrophy is the Most Prominent Histological Change in Crohn's Fibrostenosing Bowel Strictures: A Semiquantitative Analysis by Using a Novel Histological Grading Scheme. J Crohns Colitis. 2017;11(1):92-104. doi:10.1093/ecco-jcc/jjw126.
13. Zhao JF, Ling FM, Li JR, Chen YD, Huang L, Zhu LR. Role of non-inflammatory factors in intestinal fibrosis. J Dig Dis. 2020;21(6):315-318. doi:10.1111/1751-2980.12883.
14. Panés J, Bouzas R, Chaparro M, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther. 2011;34(2):125-145. doi:10.1111/j.1365-2036.2011.04710.
15. Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults [published correction appears in Gut. 2021 Apr;70(4):1]. Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/gutjnl-2019-318484
16. Koutroumpakis E, Katsanos KH. Implementation of the simple endoscopic activity score in Crohn's disease. Saudi J Gastroenterol. 2016;22(3):183-191. doi:10.41 03/1319-3767.182455
17. Chang CW, Wong JM, Tung CC, Shih IL, Wang HY, Wei SC. Intestinal stricture in Crohn's disease. Intest Res. 2015;13(1):19-26. doi:10.5217/ir.2015.13.1.19
18. Bruining DH, Zimmermann EM, Loftus EV Jr, et al. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. Gastroenterology. 2018; 154 (4):1172-1194. doi:10.1053/j.gastro .2017.11.274
19. Baumgart DC, Le Berre C. Newer Biologic and Small-Molecule Therapies for Inflammatory Bowel Disease. N Engl J Med. 2021;385(14):1302-1315. doi:10.1056/NEJMra1907607
20. Torres J, Bonovas S, Doherty G, et al. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis. 2020;14(1):4-22. doi:10.1093/ecco-jcc/jjz180
21. El Ouali S, Click B, Holubar SD, Rieder F. Natural history, diagnosis and treatment approach to fibrostenosing Crohn's disease. United European Gastroenterol J. 2020;8(3):2 63-270. doi:10.1177/2050640620901960. PM ID: 32213020
22. Bettenworth D, Gustavsson A, Atreja A, 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):133-142. doi:10.1097/MIB.0000000000000988
23. Thienpont C, D'Hoore A, Vermeire S, et al. Long-term outcome of endoscopic dilatation in patients with Crohn's disease is not affected by disease activity or medical therapy [published correction appears in Gut. 2010 Jul;59(7):1007]. Gut. 2010; 59(3):320-324. doi:10.1136/gut.2009.180182
24. Lu C, Baraty B, Lee Robertson H, et al. Systematic review: medical therapy for fibrostenosing Crohn's disease. Aliment Pharmacol Ther. 2020; 51(12):1233-1246. doi:10.1111/apt.15750
25. Attar A, Maunoury V, Vahedi K, et al. Safety and efficacy of extractible self-expandable metal stents in the treatment of Crohn's disease intestinal strictures: a prospective pilot study. Inflamm Bowel Dis. 2012;18(10):1849-1854. doi:10.1002/ibd.22844
26. Adamina M, Bonovas S, Raine T, et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment. Journal of Crohn’s and Colitis. 2019;14(2):155–168. doi:10.1093/ecco-jcc/jjz187
27. Levine RA, Wasvary H, Kadro O. Endoprosthetic management of refractory ileocolonic anastomotic strictures after resection for Crohn's disease: report of nine-year follow-up and review of the literature. Inflamm Bowel Dis. 2012; 18(3):506-512. doi: 10.1002/ibd.21739
28. Navaneethan U, Lourdusamy D. Endoscopic Stricturotomy and Strictureplasty. Gastrointest Endosc Clin N Am. 2022;32 (4):687-697. doi:10.1016/j.giec.2022.05.002
29. Shen B, Kochhar G, Navaneethan U, et al. Practical guidelines on endoscopic treatment for Crohn's disease strictures: a consensus statement from the Global Interventional Inflammatory Bowel Disease Group. Lancet Gastroenterol Hepatol. 2020;5(4):393-405. doi:10.1016/S2468-1253(19)30366-8
30. Lan N, Shen B. Endoscopic Stricturotomy Versus Balloon Dilation in the Treatment of Anastomotic Strictures in Crohn’s Disease. Inflamm Bowel Dis. 2018;24:897–907. doi:10. 1093/ibd/izx085.