ASGE Interventional IBD: Management of Complications (On-Demand)| March 2022-Endoscopic Stricturotomy and Stricturoplasty: Time to Replace Balloon Dilation and Surgery?

Video Transcription

Video Summary

In this video, Dr. Uday Navalithan, the medical director and director of the IBD Center at Central Florida University, discusses the topic of Endoscopic Stricturotomy and Stricturoplasty. He begins by explaining that strictures in patients with Crohn's disease can pose a challenge, and the decision to give medication or try endoscopic treatment or surgery depends on the severity and location of the stricture. He discusses the different techniques for endoscopic treatment, focusing on stricturotomy, which involves cutting the stricture using a needle knife or an IT knife. He emphasizes the importance of accurately defining the appearance and length of the stricture to determine the appropriate treatment plan. Dr. Navalithan also discusses the use of clips as spacers to prevent the stricture from recurring. He compares the effectiveness and risks of stricturotomy and endoscopic balloon dilation, and highlights the need for follow-up therapy to prevent stricture recurrence. He concludes by presenting his algorithm for the management of strictures in patients with Crohn's disease, considering factors such as location, length, and underlying inflammation. Dr. Navalithan suggests that in many cases, stricturotomy may be a preferable alternative to endoscopic balloon dilation, but surgery may still be necessary in some situations. He also mentions the challenges associated with the lack of specific training and coding for stricturotomy, as well as the cost of specialized equipment. Overall, he believes stricturotomy is an effective technique for managing strictures in patients with Crohn's disease, but surgery still plays an important role in certain cases.

Asset Subtitle

Udayakumar Navaneethan, MD, FASGE

Keywords

Endoscopic Stricturotomy

Stricturoplasty

Crohn's disease

stricture

endoscopic treatment

surgery