Endoscopic stricture management in inflammatory bowel disease: Present and future

Abstract

Endoscopic stricture management has revolutionized the care of inflammatory bowel disease (IBD), particularly Crohn’s disease (CD), offering minimally invasive options to delay or replace surgery. Endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES) and self-expanding metal stents (SEMS) are the mainstays for fibrotic or mixed strictures. Hybrid techniques such as combining EBD/SEMS and ES or adjunctive use of novel drug-coated balloons are evolving approaches. However, recurrence remains a major challenge with EBD, with up to two-thirds of patients requiring re-intervention. ES has higher long-term efficacy than EBD. Fully covered and partially covered self-expanding metal stents (SEMS) may be useful in long and refractory strictures whereas lumen-apposing metal stents (LAMS) can be used in short and anastomotic strictures. This manuscript reviews the present modalities, their outcomes and promising future advancements in endoscopic stricture management in CD. Interventional IBD (IIBD) plays a key role in the multi-disciplinary management of complex IBD acting as a bridge between medical and surgical therapy for properly selected IBD patients.