Rectal stricture dilatation under direct vision with an over-the-scope BougieCap

We describe dilatation of a rectal stricture secondary to Crohn's disease using an Ovesco BougieCap-a fixed-diameter push-type dilator. The BougieCap's clear walls allow direct vision, and conical shape enables controlled gradual dilatation to a maximum diameter of 12 mm/36 Fr facilitating subsequent flexible sigmoidoscopy using the same endoscope. A patient with a benign low rectal stenosis due to Crohn's disease underwent general anaesthesia for flexible sigmoidoscopy. Her stenosis symptoms included liquid seepage and obstructed defecation. A 12 mm gastroscope could not be passed due to the severity of anorectal stenosis not admitting a little finger. Once the BougieCap dilator was positioned over the gastroscope, the stricture could be gently traversed under direct vision. The lumen was always visible. Flexible sigmoidoscopy and stricture biopsy then took place. At 6, 12 and 18 months follow-up, she reported a consistent improvement in symptoms. Prospective studies are required to establish long-term usefulness of this technique.