Strictureplasty in Selected Crohn’s Disease Patients Results in Acceptable Long-term Outcome

Bellolio, Felipe; Cohen, Zane; MacRae, Helen; O’Connor, Brenda I.; Victor, J. Charles; Huang, Harden; McLeod, Robin S.

doi:10.1097/dcr.0b013e318258f5cb

Cited by 28 publications

(10 citation statements)

References 15 publications

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“…Strictureplasty is an established and safe surgical option for treating strictures related to CD and is an alternative to bowel resection 80,81 . Strictureplasty is recommended whenever reasonable and technically feasible, particularly with multiple fibrotic strictures that would otherwise require more than a minimal bowel resection 11,82 .…”

Section: Disease Strictureplasty May Be Preferable To Resection Of Lmentioning

confidence: 99%

ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment

Torres

Bonovas

Doherty

et al. 2019

Journal of Crohn's and Colitis

607

336

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This article is the second in a series of two publications relating to the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn’s disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn’s disease and an update of previous guidelines.

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Section: Disease Strictureplasty May Be Preferable To Resection Of Lmentioning

confidence: 99%

ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment

Torres

Bonovas

Doherty

et al. 2019

Journal of Crohn's and Colitis

607

336

View full text Add to dashboard Cite

show abstract

“…The Heineke-Mikulicz and Finney techniques are the most common types of stricturoplasty procedures[41]. Other techniques of stricturoplasties such as the Michelassi technique and modified approaches have also been reviewed in meta-analyses, and are considered safe[42].…”

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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“…In patients with CD, the complication rate can be as high as 20%[ 3 ]. Besides the direct complications of surgery, there is also a > 70% chance of re-stricturing and it is known that multiple small intestinal resections can lead to short bowel syndrome and malnutrition[ 4 - 6 ]. Endoscopic balloon dilation (EBD) has been extensively described for fibrostenosing CD as it is minimally invasive and preserves intestinal length[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: A systematic review

Baars

Theyventhiran

Aepli

et al. 2017

WJG

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AIMTo evaluate the therapeutic role of double-balloon enteroscopy (DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODSSystematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded.RESULTSIn total 13 studies were included, in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation, 46% were treated with re-dilatation and only 17% required surgery.CONCLUSIONDBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.

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Strictureplasty in Selected Crohn’s Disease Patients Results in Acceptable Long-term Outcome

Cited by 28 publications

References 15 publications

ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment

ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment

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

Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: A systematic review

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