Endoscopic and Radiological Outcomes of Strictureplasty in Patients With Small Bowel Stricturing Crohn's Disease

Endoscopic and radiologic changes following strictureplasty for Crohn's disease (CD) remain largely unknown. This study aimed to evaluate postoperative mucosal and transmural healing at strictureplasty sites.

A retrospective cohort study using a prospectively maintained database of patients undergoing surgery for small-bowel stricturing CD between October 2014 and January 2024 was conducted. Propensity score matching was performed to generate a contextual comparison group of patients undergoing intestinal resection. Endoscopic and radiological outcomes were evaluated using postoperative computed tomography enterography (CTE) and enteroscopy.

59 patients undergoing strictureplasty were included. Postoperative endoscopy showed mucosal healing at the primary strictureplasty site in 46 of 59 patients (78%, Median follow-up 8 months). CTE showed a marked reduction in bowel wall thickness compared to preoperative measurements (8.25 mm vs. 5.6 mm, p < 0.001) (Median follow-up 7 months). At the final follow-up (median follow-up 12 months), clinical recurrence requiring treatment escalation, was observed in 38/51 (75%) patients, and 23 (61%) of these recurrences were due to new sites rather than the strictureplasty site. No statistically significant difference in clinical recurrence was observed between the strictureplasty and matched resection cohorts (p = 0.74).

Significant mucosal and transmural healing occurred at the site of the primary stricture within approximately 1 year of strictureplasty. Preservation of diseased bowel did not appear to increase short-term clinical recurrence in this cohort.