Post written by Julien D. Schulberg, MBBS, PhD, and Michael A. Kamm, MBBS, PhD, from the Department of Gastroenterology, St Vincent’s Hospital, and the Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

The focus of this study was to evaluate the safety, feasibility, and efficacy of intensive endoscopic therapy for treating symptomatic Crohn’s disease—related strictures. It compares standard single endoscopic balloon dilation (EBD) with the more intensive strategies of repeated balloon dilation and needle-knife stricturotomy (NKSt) combined with intense anti-inflammatory drug treatment. The hypothesis was that repeated endoscopic interventions alongside effective inflammation control would provide a superior outcome than with single EBD.

Crohn’s disease—related strictures are a common adverse event that significantly impacts patients’ quality of life. Although single EBD is a standard treatment, a substantial number of patients eventually require surgery. A less-invasive yet effective alternative, such as repeated EBD combined with NKSt, could reduce the need for surgical interventions and associated adverse events. Current evidence on advanced endoscopic techniques such as NKSt is limited and mostly based on small retrospective studies. This study provides prospective data that validate these methods and potentially establish a new standard of care.

The results suggest that intensive endoscopic treatment may be superior to standard single EBD. Sixteen of the 21 patients completed the 6-month study with 2 of 5 (40%) with a single EBD and 12 of 16 (72%) with intensive treatment having symptom improvement. In those who underwent repeated NKSt, 4 of 5 patients (80%) had symptom improvement. In patients where drug therapy was introduced or escalated, ulceration (P = .048) and symptoms (P = .047) were significantly less at 6 months. This is consistent with the benefit of intense anti-inflammatory drug treatment for symptomatic strictures seen in controlled studies.¹

This prospective study adds to small and retrospective studies on intensive endoscopic strategies for strictures and their role in improving clinical outcomes. Larger randomized trials are required to strengthen the evidence for incorporating repeated EBD and NKSt into standard care.

A, An end-to-end ileocolic anastomotic stricture, circumferentially inflamed. B, A needle-knife stricturotomy was performed using 3 radial incisions. C, Postapplication of endoscopic clips, applied to prevent incised edges from adhering back together to maintain stricture patency.

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1. Schulberg JD, Wright EK, Holt BA, et al. Intensive drug therapy versus standard drug therapy for symptomatic intestinal Crohn’s disease strictures (STRIDENT): an open-label, single-centre, randomised controlled trial. Lancet Gastroenterol Hepatol 2022;7:318-31. ↩︎