Endoprosthetic management of refractory ileocolonic anastomotic strictures after resection for Crohnʼs disease: Report of nine-year follow-up and review of the literature

Levine, Rebecca; Wasvary, Harry; Kadro, Omar

doi:10.1002/ibd.21739

Cited by 61 publications

(45 citation statements)

References 25 publications

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“…Observational data are available for CD-associated strictures. The technical and clinical success rate is as high as 100%, but initial enthusiasm has been dampened because two thirds of the patients had major complications, such as stent migration and fistula formation leading to perforations 133 . One alternate solution to these complications is the use of biodegradable stents, but there have been only a small number of reports on this approach 134 .…”

Section: Management Of Fibrostenosing Ibdmentioning

confidence: 99%

Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases

2017

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In the last 10 years, we have learned much about the pathogenesis, diagnosis, and management of intestinal fibrosis in patients with inflammatory bowel diseases (IBD). Just a decade ago, intestinal strictures were considered to be an inevitable consequence of long-term inflammation in patients who did not respond to anti-inflammatory therapies. IBD-associated fibrosis was seen as an irreversible process that frequently led to intestinal obstructions requiring surgical intervention. This paradigm has changed rapidly, due to the anti-fibrotic approaches that may become available. We review the mechanisms and diagnosis of this serious complication of IBD, as well as factors that predict its progression and management strategies.

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Section: Management Of Fibrostenosing Ibdmentioning

confidence: 99%

Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases

2017

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“…The initial success rate was reported to be 100%, but major complications, such as migration, perforation or fistulisation were frequent (67% of patients). 136 In a prospective cohort study with 11 patients the authors concluded that the complication rate is too high to make this a routine treatment option, even when extractable stents are used. 137 138 Biodegradable stents might be an emerging alternative.…”

Section: Therapymentioning

confidence: 99%

Crohn's disease complicated by strictures: a systematic review

Rieder

Zimmermann

Remzi

et al. 2013

Gut

409

318

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The occurrence of strictures as a complication of Crohn’s disease is a significant clinical problem. No specific antifibrotic therapies are available. This systematic review comprehensively addresses the pathogenesis, epidemiology, prediction, diagnosis and therapy of this disease complication. We also provide specific recommendations for clinical practice and summarise areas that require future investigation.

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“…Stenting for CD strictures has been described in case reports with reasonable short term outcomes[53-55]. However, this is not commonly performed, and there is insufficient evidence to recommend this practice.…”

Section: Surgical Options In Small Bowel and Large Bowel CDmentioning

confidence: 99%

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Toh¹,

Stewart²,

Rickard³

et al. 2016

WJG

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Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

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Endoprosthetic management of refractory ileocolonic anastomotic strictures after resection for Crohnʼs disease: Report of nine-year follow-up and review of the literature

Abstract: Endoluminal stenting of CD strictures is a safe and effective alternative to surgery which can provide lasting benefit in select patients. Further studies are necessary to clarify the full impact of this technology on long-term management of this complex disease.

Cited by 61 publications

References 25 publications

Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases

Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases

Crohn's disease complicated by strictures: a systematic review

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

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