Diagnostic and therapeutic yield of push-and-pull enteroscopy for symptomatic small bowel Crohn's disease strictures

Crohn's disease is frequently complicated by obstructive symptoms secondary to small bowel strictures that cannot be accessed by conventional endoscopy. Push-and-pull enteroscopy is a new endoscopic tool that might allow not only diagnostic work-up but also therapeutic interventions of these strictures. The purpose of this study was to evaluate the feasibility and safety of push-and-pull enteroscopy in the treatment of symptomatic small bowel Crohn's disease strictures.

Between September 2003 and May 2006, 19 consecutive patients with known or suspected Crohn's disease and symptomatic small bowel strictures were subjected to push-and-pull enteroscopy and included in our analysis.

With push-and-pull enteroscopy at least one small bowel stricture was accessed in each patient. On the basis of endoscopic assessment strictures in nine patients were not amenable to endoscopic therapy because of anatomical reasons (3/9) or severe inflammatory activity within the stenotic segment (6/9). They underwent direct surgery or intensified immunomodulatory treatment, respectively. In 10 patients with 13 strictures we performed 15 dilations in combination with push-and-pull enteroscopy under fluoroscopic guidance. Technical success was achieved in 8/10 patients, symptomatic relief with avoidance of surgery was achieved in 6/10 patients who remained symptom free during a mean follow-up period of 10 months (range, 4-16 months). No complications were encountered after dilation.

Push-and-pull enteroscopy is very useful for diagnosis and directing therapy in patients with Crohn's disease-associated strictures within the small bowel. Balloon dilation with the push-and-pull enteroscopy device appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory strictures.