Endoscopic radial incision and cutting for Crohn’s Disease-associated intestinal stricture: a pilot study

Abstract

Background and study aims Intestinal stricture associated with Crohn’s disease (CD) is usually treated by endoscopic balloon dilation (EBD) or stricture plasty. Although EBD is effective and safe for such strictures, refractory stricture after EBD poses a problem. Hence, other novel approaches for these refractory strictures are required. On the other hand, the efficacy of radial incision and cutting (RIC) method for esophageal stricture after esophagogastric surgery is reported. In this pilot study, we adopted the RIC technique for five CD patients with refractory intestinal stricture to dilate their strictures. We conducted the RIC procedure using an electric needle knife with a ceramic tip on the top of the needle. Four cases were of anastomotic stricture after ileocecal resection and the remaining one case was of stricture due to mucosal healing. The RIC procedure was successful for all five patients. Average procedure time was 18.6 minutes. One patient developed delayed bleeding after RIC. There were no cases of perforation. RIC could be an alternative therapy for intestinal stricture associated with CD. Further studies should be conducted to clarify its efficacy and safety.

Retrieval of retained capsule endoscopy by device‐assisted enteroscopy in patients with cryptogenic multifocal ulcerous stenosing enteritis

“…Although intestinal stenosis has diverse causes, a recent study showed that RIC can be used to treat any type of stenosis (primary or secondary) less than 2 cm in length. 18 We successfully conducted RIC in a patient with CMUSE and intestinal stenosis using SBE, and no adverse events occurred. The patient was asymptomatic during the 3-month follow-up.…”

“…3 RIC is effective for treating refractory benign esophageal strictures, benign anastomotic stenoses, and CD-associated intestinal strictures. [18][19][20][21] At present, the indications of RIC are not clear.…”

“…17 EBD is known to be safe for both shortterm and long-term prognosis. 18 A recent study reported the use of EBD in three cases of CMUSE-associated intestinal stricture under DAE. 3 RIC is effective for treating refractory benign esophageal strictures, benign anastomotic stenoses, and CD-associated intestinal strictures.…”

IT Knife-Assisted Balloon Stricturoplasty in a Patient With Crohn's Disease

“…However, IT knife stricturoplasty to treat refractory fibrostenotic strictures has been described only in a few case reports. 4 – 6 We present a patient with Crohn's disease whose abdominal pain resolved after IT knife stricturoplasty of colorectal strictures and fecalith decompaction of a diverticulum.…”

A Pilot Study Investigating the Safety and Feasibility of Endoscopic Dilation Using a Radial Incision and Cutting Technique for Benign Strictures of the Small Intestine: A Study Protocol

“…We previously reported the e cacy of radial incision and cutting (RIC) method for intestinal strictures in ve patients with Crohn's disease (CD) as a pilot study [14]. RIC was initially reported as a dilation technique for refractory stenoses that developed after surgical resection of esophagogastric diseases.…”