The role of endoscopy in the evaluation and management of intestinal strictures in inflammatory bowel disease

The prevalence of intestinal strictures in Crohn's disease is quite high, especially for those with ileal or ileocolonic disease. Strictures resulting in obstructive symptoms are the indication for surgery in a significant portion. In the modern era, the prevalence of colorectal strictures in ulcerative colitis has decreased, perhaps to as low as 3%. In general, the finding of a stricture in Crohn's disease is less ominous than in ulcerative colitis in terms of the risk of malignancy. Endoscopy allows for direct visualization and biopsy of colorectal strictures and may help patients avoid surgery; however, cases of malignant strictures with negative endoscopic biopsies have been reported. Numerous case series have demonstrated that endoscopic balloon dilation of Crohn's-related colorectal or anastomotic strictures is technically feasible, relatively safe, and in many cases effective in preventing or delaying surgical resection or stricturoplasty. Local injection of corticosteroids such as betamethasone or triamcinolone following balloon dilation may provide additional benefit, although this has not been definitively proven. Other endoscopic techniques that may ultimately prove effective but need further study include the use of electrocautery or laser phototherapy.