Endoscopic therapy of strictures in Crohn's disease

It is clear that endoscopic balloon dilatation of ileocolic and other intestinal strictures are possible in the Crohn's patient. However, patients need to be highly and carefully selected in order to maximize technical success and minimize complications. Recommended criteria for balloon dilatation include 1) short stricture; 2) minimal inflammation; 3) no evidence of fistula or angulation of stricture; 4) no evidence of cancer; 5) stricture easily reachable by scope; and 6) preferably a single dominant, symptomatic stricture. Other factors that facilitate successful dilatation include the need for sophisticated technology (types of catheters), fluoroscopy, anesthesia, and, finally, surgical backup. In the aggregate, it will be the rare patient and/or endoscopy facility that will comfortably satisfy all these criteria. Then, even when successfully completed, a third to a half of patients will require repetitive dilatation, increasing complications and costs, and still having a 50% need for surgical operation at 5 years. Clearly, the use of endoscopic balloon dilatation in CD has a very limited role. It must be carefully weighed against a more definitively successful, more widely applicable, and probably safer surgical resection.