Cui L, Su M, Ding YB, Wang M, Sun KW. Preliminary study on the clinical value of endoscopic stricturotomy in the treatment of stricturing Crohn's disease. World J Gastrointest Surg 2025; 17(2): 100631 [DOI: 10.4240/wjgs.v17.i2.100631]
Corresponding Author of This Article
Mei Wang, Chief Physician, Department of Gastroenterology, The Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Changzhou 213000, Jiangsu Province, China. maywang2007@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2025; 17(2): 100631 Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.100631
Preliminary study on the clinical value of endoscopic stricturotomy in the treatment of stricturing Crohn's disease
Lu Cui, Min Su, Yan-Bo Ding, Mei Wang, Ke-Wen Sun
Lu Cui, Min Su, Yan-Bo Ding, Mei Wang, Ke-Wen Sun, Department of Gastroenterology, The Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu Province, China
Co-corresponding authors: Mei Wang and Ke-Wen Sun.
Author contributions: All authors participated in the conception and design of the study; Cui L, Su M, Ding YB, Wang M and Sun KW devised the research; Wang M executed the endoscopic stricturotomy; Cui Land Su M screened patients and acquired clinical data; Ding YB performed data analysis; Sun KW carried out supervision and validation; Cui L drafted the initial manuscript; All authors provided comments on previous versions. Both Wang M and Sun KW have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Wang M performed endoscopic operations. She consulted the literature and revised the early version of the manuscript. Sun KW conceived, designed, and supervised the entire process of the project. He combined the analyzed data with national and international studies to further explain the utility of endoscopic stricturotomy. The collaboration between Wang M and Sun KW was crucial to the publication of the manuscript.
Institutional review board statement: The study was retrospective and has been approved by the Ethics Committee of The First People’s Hospital of Changzhou (2024 Section 180).
Informed consent statement: The study was a retrospective study. The data were anonymous, and the requirement for informed consent was therefore waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request at maywang2007@hotmail.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei Wang, Chief Physician, Department of Gastroenterology, The Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Changzhou 213000, Jiangsu Province, China. maywang2007@hotmail.com
Received: August 22, 2024 Revised: November 22, 2024 Accepted: December 17, 2024 Published online: February 27, 2025 Processing time: 153 Days and 19.3 Hours
Abstract
BACKGROUND
Crohn's disease (CD) frequently leads to intestinal strictures, which pose significant challenges due to their complexity and limited treatment options. While medications can address inflammatory strictures, they are largely ineffective for fibrotic and mixed strictures, often necessitating surgical intervention. However, surgery carries considerable risks, including bleeding, infection, anastomotic leaks, and postoperative restricture formation. Endoscopic treatment, particularly endoscopic stricturotomy, offers a minimally invasive alternative that bridges the gap between medication and surgery.
AIM
To investigate the safety and efficacy of stricturotomy under single-balloon enteroscopy in stricturing CD.
METHODS
Patients diagnosed with stricturing CD at The First People's Hospital of Changzhou from June 2020 to April 2024 were enrolled and underwent endoscopic stricturotomy (ES). Relevant clinical data of patients were collected retrospectively. Outcomes included success rate, remission time, complications, and follow-up interventions. This observational study was followed up postoperatively to observe patient remission and recurrence rates.
RESULTS
Seventeen endoscopic strictures were created in 11 patients, achieving a 100% immediate success rate without any serious complications. During the follow-up period, stricture recurrence was observed in two patients, resulting in an endoscopic reintervention rate of 18.2%. Additionally, two patients required subsequent surgical intervention, with a surgical treatment rate of 18.2%. One patient experienced bowel obstruction 18 months post-ES and was successfully managed with conservative treatment without surgical intervention. The remission duration after the initial ES treatment was 10.1 ± 8.2 months, with a median remission time of 10 months.
CONCLUSION
ES is a safe and effective treatment for CD-related strictures and warrants further clinical promotion and application.
Core Tip: This study evaluated the efficacy and safety of endoscopic stricturotomy (ES) for treating stricturing Crohn's disease in 11 patients. ES achieved a 100% immediate success rate with no significant complications. During follow-up, symptom relief was maintained for a median of 10 months, and the need for surgical intervention was reduced. ES was particularly effective for short-segment, solitary strictures and provided precise, minimally invasive treatment. These findings suggest ES is a viable alternative to surgery, which improves patient outcomes and delays recurrence or progression. Further research with larger sample sizes and multicenter studies is needed to validate these results.
