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Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

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Abstract

Crohn’s disease (CD) is a chronic inflammatory bowel disease that can involve virtually any part of the gastrointestinal tract. CD complications are the main indications for surgery. A large proportion of these interventions are due to stricturing disease. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD. Unfortunately, surgery is not curative, as the disease ultimately reoccurs in a substantial subset of patients. To best identify the patients who will require a specific treatment and to plane the most appropriate therapeutic approach, it is important to precisely define the type, the size, and the location of CD stenosis. Diagnostic approaches aim to distinguish fibrotic from inflammatory strictures. Medical therapy is required for inflammatory stenosis. Mechanical treatments are required when fibrotic CD strictures are symptomatic. The choice between endoscopic balloon dilation, stricturoplasty, and laparoscopic or open surgery is based on the presence of perforating complications, the remaining length of small bowel, and the number and length of strictures. The non-hierarchical decision-making process for the treatment of fibrotic CD therefore requires multidisciplinary clinical rounds with radiologists, gastroenterologists, interventional endoscopists, and surgeons.

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Authors and Affiliations

  1. Department of Surgery, Laiboisiere Hospital, Paris 7 University and AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Brice Malgras, Karine Pautrat, Pierre Pasquier, Patrice Valleur & Marc Pocard

  2. Department of Gastroenterology and Hepatology, Lariboisiere Hospital, Paris 7 University and AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Xavier Dray

  3. Université Diderot, Paris 7, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010, Paris, France

    Xavier Dray, Patrice Valleur, Marc Pocard & Philippe Soyer

  4. Department of Abdominal and Interventional Imaging, Lariboisiere Hospital, Paris 7 University and AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Philippe Soyer

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  1. Brice Malgras
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Malgras, B., Pautrat, K., Dray, X. et al. Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease. Dig Dis Sci 60, 1152–1168 (2015). https://doi.org/10.1007/s10620-014-3421-y

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