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Purpose of Review <p>Complicated Crohn’s disease in the small bowel is often associated with structural complications, particularly strictures. Endoscopy plays a key role in the diagnosis, disease monitoring, and therapy of small bowel CD. This article will provide state-of-the-art endoscopic treatment modalities for small bowel complications in CD.</p> Recent Findings <p>Endoscopic therapy for small bowel disease can be delivered through upper endoscopy, push enteroscopy, ileocolonoscopy, device-assisted enteroscopy, intraoperative enteroscopy, and ileoscopy. In addition to persistent medical therapy, endoscopic treatment is performed using bare- or drug-coated balloon dilation, electrocision, and mechanical stricturectomy. Isolated ileocecal valve CD with associated stricture and adjacent fistulas comprises a unique phenotype of CD, mimicking the clinical presentation and disease course of achalasia at the gastroesophageal junction. Ileocecal valve CD can be treated with stricturectomy and fistulotomy. Endoscopy also has a major role in the treatment of surgery-associated anastomotic complications (such as stricture, bleeding, and leaks).</p> Summary <p>Endoscopic treatment should be attempted in patients with&#xa0;short (&lt;4-5) small bowel strictures on top of medical therapy. Isolated&#xa0;ileocecal valve CD represents a unique phenotype of CD consisting of&#xa0;inflammation, stricture, and fistula at and around the valve, which is amenable for endoscopic therapy.</p>

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Endoscopic Management of Complicated Small Bowel Crohn’s Disease

  • 期刊论文

  • 发表日期：

    2025年9月29日

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  • Bo Shen

摘要

Purpose of Review

Complicated Crohn’s disease in the small bowel is often associated with structural complications, particularly strictures. Endoscopy plays a key role in the diagnosis, disease monitoring, and therapy of small bowel CD. This article will provide state-of-the-art endoscopic treatment modalities for small bowel complications in CD.

Recent Findings

Endoscopic therapy for small bowel disease can be delivered through upper endoscopy, push enteroscopy, ileocolonoscopy, device-assisted enteroscopy, intraoperative enteroscopy, and ileoscopy. In addition to persistent medical therapy, endoscopic treatment is performed using bare- or drug-coated balloon dilation, electrocision, and mechanical stricturectomy. Isolated ileocecal valve CD with associated stricture and adjacent fistulas comprises a unique phenotype of CD, mimicking the clinical presentation and disease course of achalasia at the gastroesophageal junction. Ileocecal valve CD can be treated with stricturectomy and fistulotomy. Endoscopy also has a major role in the treatment of surgery-associated anastomotic complications (such as stricture, bleeding, and leaks).

Summary

Endoscopic treatment should be attempted in patients with short (<4-5) small bowel strictures on top of medical therapy. Isolated ileocecal valve CD represents a unique phenotype of CD consisting of inflammation, stricture, and fistula at and around the valve, which is amenable for endoscopic therapy.