Chapter 22 - Multidisciplinary Approach to Stricturing Crohn's Disease: Medical Versus Endoscopic Versus Surgical Therapy

Abstract

A majority of patients with Crohn's disease (CD) eventually develop disease-associated complications, such as stricture and fistula. The stricture is characterized by progressive luminal narrowing with inflammatory and fibrosing components and clinically with obstructive symptoms. Various antiinflammatory and immunosuppressive medications have been used in treating inflammatory and fistulizing CD. The efficacy and safety of biological agents in treating Crohn's stricture have been a concern CD. Rapid tissue healing from potent biological agents may trigger or exacerbate stricture. On the other hand, strictures have been one of main indications for surgical intervention. In the majority of patients, surgery is not a cure. Disease recurrence is common at the anastomotic site and bowel segment above the anastomosis. The progressive nature of the disease with repetitive cycle of inflammation and fibrosis results in recurrent stricture and repeated surgery, with a risk of short bowel syndrome. Surgical stricturoplasty and endoscopic balloon dilation and recently endoscopic stricturotomy have emerged as valid alternatives. There are pros and cons of each treatment modality. The choice among the treatment options is determined by the nature of stricture, disease, systemic conditions of individual patient, and local expertise in endoscopy versus surgery.