Endoscopic stricturotomy and strictureplasty for Crohn's disease-related duodenal strictures

Duodenal stricturing in Crohn's disease is rare, and its management has been challenging. Fibrotic or mixed inflammatory/fibrotic primary strictures of Crohn's disease do not respond well to medical therapy, eventually requiring endoscopic or surgical intervention. Endoscopic balloon dilation has been considered a middle-of-the-road strategy between medical and surgical approaches but is limited by its efficacy in primary stricture, recurrence, and frequent need for redilation. To address these issues, novel strategies, including endoscopic stricturotomy and strictureplasty utilizing electroincision, have been developed. This study aimed to analyze the effectiveness and safety of endoscopic electroincision therapy in Crohn's disease-related duodenal strictures in a small cohort of consecutive patients.

Data on patients diagnosed with Crohn's disease and duodenal strictures who were treated with endoscopic electroincision were consecutively extracted from the interventional inflammatory bowel disease unit from December 2, 2019, to January 31 of 2024. All patients with anastomotic stricture were excluded from the study. The primary outcomes were surgery-free survival and postprocedural adverse events.

Eight endoscopic electroincision therapies were performed in 5 patients for Crohn's disease-induced duodenal stricture. The study found a technical success rate of 88%, and a clinical response rate of 100%. The adverse event rate was unremarkable. The rate of endoscopic retreatment was 60%, with a minimum 6-month interval. In follow-up, no patient required surgical intervention.

Both endoscopic stricturotomy and strictureplasty seem to be effective and safe therapeutic modalities for Crohn's disease-associated duodenal stricture.