Lai WC, Feng XM, Huang ZH, Jiang ZM, Sun T, Yin X, Zhang L, Ning SB, Li BR. Balloon-assisted endoscopic stricturotomy for small bowel fibrostenotic strictures: A comparison of Crohn’s disease-related and non-Crohn’s disease strictures. World J Gastroenterol 2026; 32(26): 118889 [DOI: 10.3748/wjg.118889]
Corresponding Author of This Article
Bai-Rong Li, MD, PhD, Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, No. 30 Fuchen Road, Beijing 100142, China. airbai8040@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Lai WC, Feng XM, Huang ZH, Jiang ZM, Sun T, Yin X, Zhang L, Ning SB, Li BR. Balloon-assisted endoscopic stricturotomy for small bowel fibrostenotic strictures: A comparison of Crohn’s disease-related and non-Crohn’s disease strictures. World J Gastroenterol 2026; 32(26): 118889 [DOI: 10.3748/wjg.118889]
World J Gastroenterol. Jul 14, 2026; 32(26): 118889 Published online Jul 14, 2026. doi: 10.3748/wjg.118889
Balloon-assisted endoscopic stricturotomy for small bowel fibrostenotic strictures: A comparison of Crohn’s disease-related and non-Crohn’s disease strictures
Wen-Cai Lai, Xiao-Meng Feng, Zhi-Han Huang, Zhi-Meng Jiang, Tao Sun, Xin Yin, Lei Zhang, Shou-Bin Ning, Bai-Rong Li
Wen-Cai Lai, Zhi-Meng Jiang, Graduate School, Hebei North University, Zhangjiakou 075031, Hebei Province, China
Wen-Cai Lai, Xiao-Meng Feng, Zhi-Han Huang, Zhi-Meng Jiang, Tao Sun, Xin Yin, Lei Zhang, Shou-Bin Ning, Bai-Rong Li, Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
Co-first authors: Wen-Cai Lai and Xiao-Meng Feng.
Co-corresponding authors: Shou-Bin Ning and Bai-Rong Li.
Author contributions: Ning SB and Li BR designed the research study and critically revised the manuscript for important intellectual content and they contribute equally to this study as co-corresponding authors; Lai WC and Feng XM analyzed the data and drafted the manuscript and they contribute equally to this study as co-first authors; Lai WC, Feng XM, Huang ZH, and Jiang ZM collected the data; Li BR, Sun T, Yin X, and Zhang L performed the endoscopic stricturotomy procedures; all authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.
Supported by the Capital Health Research and Development Special Fund, No. 2020-4-5123.
Institutional review board statement: This study was approved by the Ethics Committee of the Air Force Medical Center, Air Force Medical University (Approval No. 2022-170-PJ01).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are not publicly available due to institutional regulations on patient privacy but are available from the corresponding author upon reasonable request.
Corresponding author: Bai-Rong Li, MD, PhD, Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, No. 30 Fuchen Road, Beijing 100142, China. airbai8040@163.com
Received: January 16, 2026 Revised: February 17, 2026 Accepted: March 9, 2026 Published online: July 14, 2026 Processing time: 162 Days and 21.5 Hours
Abstract
BACKGROUND
Small-bowel fibrostenotic strictures often cause obstructive symptoms and require repeated interventions. Endoscopic stricturotomy (ESt) is a minimally invasive treatment option; however, whether reintervention-free survival differs by stricture etiology and which baseline factors influence reintervention risk remain uncertain.
AIM
To compare the reintervention-free survival after ESt between Crohn’s disease (CD)-related and non-CD small-bowel strictures and to evaluate the prognostic value of inflammatory biomarkers.
METHODS
We retrospectively reviewed 57 patients with small bowel strictures who underwent balloon-assisted enteroscopy-guided ESt at our center between April 2018 and April 2025. The primary outcome was reintervention-free survival. Kaplan-Meier survival analysis together with Cox proportional hazards modeling was performed to explore factors related to reintervention. Composite inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), were evaluated.
RESULTS
Reintervention-free survival was significantly higher in patients with non-CD strictures than in those with CD-related strictures. At 1 year, the reintervention-free survival rate was 82.2% vs 54.5% (log-rank P = 0.036; HR = 0.37, 95%CI: 0.15-0.94). In parsimonious multivariable analysis, non-CD etiology and baseline NLR remained independently associated with reintervention. Patients with a NLR < 2.4 had significantly higher reintervention-free survival than those with elevated NLR (P = 0.022).
CONCLUSION
ESt provides more favorable long-term outcomes in non-CD small-bowel strictures. A NLR < 2.4 predicts reduced reintervention risk and may be used for preprocedural risk stratification.
Core Tip: Endoscopic stricturotomy is an established minimally invasive treatment for small-bowel fibrostenotic strictures, but whether outcomes differ by stricture etiology is not well defined. In this retrospective study with long-term follow-up, non-Crohn’s disease strictures had more durable reintervention-free survival than Crohn’s disease-related strictures. A lower neutrophil-to-lymphocyte ratio was associated with a lower risk of reintervention, supporting its use as a simple preprocedural risk marker.
