Utility of endoscopic ileocecal valve-plasty for Crohn's disease: a propensity-matched retrospective study

Ileocecal valve (ICV) strictures complicated by pseudopolyps are sometimes endoscopically inaccessible in Crohn's disease (CD). We previously proposed "ileocecal valve-plasty" (ICVP) that first resects obstructing polypoid hyperplasia to expose the orifice. This propensity-matched, retrospective study compared the efficacy and safety of ICVP with traditional endoscopic balloon dilation/stricturotomy alone.

CD patients with fibrotic ICV stricture receiving endotherapy were enrolled (from 2014 to 2024), and divided into two groups based on their treatments. Primary outcome was stricture-free survival (SFS); secondary outcomes were technical success, adverse events and surgery rate.

A total of 78 patients with fibrotic ICV strictures were enrolled. After match, 34 patients (mean age 27.8 ± 6.8 years, 28 males) were enrolled, and each group had 17 patients. The mean length of the stricture was longer in the ICVP group (21.8 ± 5.0 vs. 17.4 ± 6.4 mm, P = 0.032). The technical success rate was 94.1% in both groups. Four patients in the ICVP group had delayed hemorrhage and needed endoscopic hemostasis. During a median follow-up of 131 weeks, the SFS had no significant differences between the two groups (P = 0.294). The 1-year SFS in the ICVP and the control group was 40 and 43.2%, respectively. One patient in the ICVP group received ileocecal resection due to stricture. Multivariate analysis identified penetrating behavior, and stricture diameter ≤ 3 mm as independent risk factors for restenosis.

ICVP safely converts anatomically unfavorable strictures into endoscopically treatable lesions, which might help in postponing or averting surgery. Prospective multicentered validation with risk stratification is warranted.