Hybrid endoscopic stricturotomy and balloon dilation of ascending colon stricture with cecal fecaliths in Crohn's disease guided by preprocedural intestinal ultrasound.

BACKGROUND AND AIMS: Endotherapy for Crohn's disease (CD) strictures has evolved as a minimally invasive alternative to surgery. Hybrid techniques combining endoscopic stricturotomy (ES) and balloon dilation (EBD) can improve outcomes. Intestinal ultrasound (IUS) has emerged as a point-of-care tool for stricture assessment. We present a case using preprocedural IUS-guided hybrid ES and EBD to manage an ascending colon stricture with proximal fecaliths in CD.

METHODS

A 47-year-old man with ileocolonic CD (Montreal classification A2, L3, B2) receiving adalimumab and azathioprine presented with recurrent obstructive symptoms. IUS identified a short, predominantly fibrotic, ascending colon stricture. Earlier computed tomography enterography 6 months back ruled out additional strictures. On colonoscopy, ES was performed using an insulated-tip knife, followed by EBD up to 12 mm. Redundant mucosa was excised, and minor bleeding controlled. The stricture was successfully traversed, and fecaliths were extracted.

RESULTS

The procedure was uneventful, and the patient was discharged the next day after adalimumab escalation. At 9-month follow-up, he remained symptom-free.

CONCLUSIONS

Hybrid ES and EBD guided by preprocedural IUS offer an effective multimodal approach for CD strictures, potentially delaying or avoiding surgery. Further studies are warranted to validate the long-term role of IUS in stricture management.