Endoscopic stricture management in inflammatory bowel disease: Present and future

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Inflammatory Bowel Disease Research

Background:

• Endoscopic stricture management significantly impacts inflammatory bowel disease (IBD), especially Crohn's disease (CD), providing alternatives to surgery.
• Fibrotic and mixed strictures in CD are primarily managed with endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES), and self-expanding metal stents (SEMS).

Purpose of the Study:

• To review current endoscopic modalities for managing strictures in Crohn's disease.
• To discuss the outcomes, challenges, and future advancements in endoscopic stricture management.
• To highlight the role of Interventional IBD (IIBD) in multidisciplinary IBD care.

Main Methods:

• Review of existing literature on endoscopic stricture management techniques in CD.
• Analysis of outcomes for EBD, ES, and SEMS, including recurrence rates.
• Exploration of hybrid techniques and novel endoscopic approaches.

Main Results:

• EBD has a high recurrence rate, necessitating re-intervention in many patients.
• Endoscopic stricturotomy (ES) demonstrates superior long-term efficacy compared to EBD.
• Different types of SEMS (fully covered, partially covered, LAMS) offer tailored solutions for various stricture types and locations.

Conclusions:

• Endoscopic management of strictures in CD is evolving, with ongoing development of hybrid and novel techniques.
• While EBD faces recurrence challenges, ES and various SEMS provide effective options.
• Interventional IBD specialists are crucial in optimizing treatment pathways for selected IBD patients.