Skip to main content
SpringerLink
Log in

Endoscopic Treatment of Complications of Inflammatory Bowel Diseases

  • Chapter
  • First Online:
Endoscopy in Inflammatory Bowel Disease

  • 1473 Accesses

Abstract

Inflammatory bowel diseases affect about 1 in 200 persons in Western countries. Patients with Crohn’s disease (CD) in particular often require surgery as disease evolves from a primarily luminal inflammatory process to a stricturing and/or penetrating disease. Endoscopic modalities are emerging as a viable and exciting alternative to surgery in a subset of patients with IBD. Endoscopic balloon dilation, with or without topical corticosteroid injection, for IBD-related strictures is a safe and effective intervention for patients with short, bland, symptomatic strictures, and may avoid the need for surgery. Novel strategies such as endoscopic needle-knife stricturotomy and stent placement may improve the durability of balloon dilation. Endoscopic intrafistular injection of fibrin glue, in conjunction with medical management, may be a therapeutic intervention for patients with CD-related fistulae; addition of adipose-derived or mesenchymal stem cells to fibrin glue may significantly improve fistula healing, but is awaiting further study. Endotherapy for an acutely bleeding Crohn’s ulcer and colonoscopic polypectomy and endoscopic mucosal resection are safe and effective treatments for adenoma and flat but raised colitis-associated colorectal neoplasia, and may obviate colectomy in patients with IBD. Endoscopy is fast emerging from a purely diagnostic modality, to a potentially therapeutic intervention in the armamentarium of gastroenterologists involved in the care of patients with IBD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. [Research Support, Non-U.S. Gov’t Review]. 2012;142(1):46–54 e42; quiz e30.

    Google Scholar 

  2. Peyrin-Biroulet L, Loftus EV, Jr., Colombel JF, Sandborn WJ. The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol. [Review]. 2010;105(2):289–97.

    Google Scholar 

  3. Frolkis AD, Dykeman J, Negron ME, Debruyn J, Jette N, Fiest KM, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: A systematic review and meta-analysis of population-based studies. Gastroenterology. [Meta-Analysis Research Support, Non-U.S. Gov’t Review]. 2013;145(5):996–1006.

    Google Scholar 

  4. Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of strictureplasty for Crohn’s disease: A systematic review and meta-analysis. Dis Colon Rectum. [Meta-Analysis Review]. 2007;50(11):1968–86.

    Google Scholar 

  5. Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L. Review article: The natural history of postoperative Crohn’s disease recurrence. Aliment Pharm Therap. [Review]. 2012;35(6):625–33.

    Google Scholar 

  6. Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc. 2013;78(6):819–35.

    Article  PubMed  Google Scholar 

  7. Itzkowitz SH, Present DH, Crohn’s, Colitis Foundation of America Colon Cancer in IBDSG. Consensus conference: colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. [Consensus Development Conference Research Support, Non-U.S. Gov’t Review]. 2005;11(3):314–21.

    Google Scholar 

  8. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: a systematic review. Gut. [Research Support, N.I.H., Extramural Review]. 2013;62(7):1072–84.

    Google Scholar 

  9. Shen B, Fazio VW, Remzi FH, Delaney CP, Achkar JP, Bennett A, et al. Endoscopic balloon dilation of ileal pouch strictures. Am J Gastroenterol. 2004;99(12):2340–7.

    Article  PubMed  Google Scholar 

  10. Hommes DW, van Deventer SJ. Endoscopy in inflammatory bowel diseases. Gastroenterology. [Review]. 2004;126(6):1561–73.

    Google Scholar 

  11. Hassan C, Zullo A, De Francesco V, Ierardi E, Giustini M, Pitidis A, et al. Systematic review: Endoscopic dilatation in Crohn’s disease. Aliment Pharm Therap. [Review]. 2007;26(11–12):1457–64.

    Google Scholar 

  12. Thienpont C, D'Hoore A, Vermeire S, Demedts I, Bisschops R, Coremans G, et al. Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut. [Evaluation Studies]. 2010;59(3):320–4.

    Google Scholar 

  13. Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C. Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn’s disease. Aliment Pharm Therap. [Research Support, Non-U.S. Gov’t]. 2012;36(2):151–8.

    Google Scholar 

  14. Wu XR, Mukewar S, Kiran RP, Remzi FH, Shen B. Surgical stricturoplasty in the treatment of ileal pouch strictures. J Gastrointest Surg. [Research Support, Non-U.S. Gov’t]. 2013;17(8):1452–61.

    Google Scholar 

  15. Di Nardo G, Oliva S, Passariello M, Pallotta N, Civitelli F, Frediani S, et al. Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn’s disease with stricture: A prospective, randomized, double-blind, controlled trial. Gastrointest Endosc. [Randomized Controlled Trial]. 2010;72(6):1201–8.

    Google Scholar 

  16. East JE, Brooker JC, Rutter MD, Saunders BP. A pilot study of intrastricture steroid versus placebo injection after balloon dilatation of Crohn’s strictures. Clin Gastroenterol Hepatol. [Randomized Controlled Trial]. 2007;5(9):1065–9.

    Google Scholar 

  17. Swaminath A, Lichtiger S. Dilation of colonic strictures by intralesional injection of infliximab in patients with Crohn’s colitis. Inflamm Bowel dis. [Case Reports Clinical Trial Review]. 2008;14(2):213–6.

    Google Scholar 

  18. Simmons DT, Baron TH. Electroincision of refractory esophagogastric anastomotic strictures. Dis Esophagus. 2006;19(5):410–4.

    Article  CAS  PubMed  Google Scholar 

  19. Ibarguen-Secchia E. Endoscopic pyloromyotomy for congenital pyloric stenosis. Gastrointest Endosc. [Clinical Trial]. 2005;61(4):598–600.

    Google Scholar 

  20. Shen B, Lian L, Kiran RP, Queener E, Lavery IC, Fazio VW, et al. Efficacy and safety of endoscopic treatment of ileal pouch strictures. Inflamm Bowel Dis. [Research Support, Non-U.S. Gov’t]. 2011;17(12):2527–35.

    Google Scholar 

  21. Loras C, Perez-Roldan F, Gornals JB, Barrio J, Igea F, Gonzalez-Huix F, et al. Endoscopic treatment with self-expanding metal stents for Crohn’s disease strictures. Aliment Pharmacol Ther. 2012;36(9):833–9.

    CAS  PubMed  Google Scholar 

  22. Attar A, Maunoury V, Vahedi K, Vernier-Massouille G, Vida S, Bulois P, et al. Safety and efficacy of extractible self-expandable metal stents in the treatment of Crohn’s disease intestinal strictures: a prospective pilot study. Inflamm Bowel Dis. [Research Support, Non-U.S. Gov’t]. 2012;18(10):1849–54.

    Google Scholar 

  23. Branche J, Attar A, Vernier-Massouille G, Bulois P, Colombel JF, Bouhnik Y, et al. Extractible self-expandable metal stent in the treatment of Crohn’s disease anastomotic strictures. Endoscopy. 2012;44 Suppl 2 UCTN:E325–326.

    Google Scholar 

  24. Rejchrt S, Kopacova M, Brozik J, Bures J. Biodegradable stents for the treatment of benign stenoses of the small and large intestines. Endoscopy. [Research Support, Non-U.S. Gov’t]. 2011;43(10):911–7.

    Google Scholar 

  25. Grimaud JC, Munoz-Bongrand N, Siproudhis L, Abramowitz L, Senejoux A, Vitton V, et al. Fibrin glue is effective healing perianal fistulas in patients with Crohn’s disease. Gastroenterology. [Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2010;138(7):2275–81, 2281 e2271.

    Google Scholar 

  26. Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. Fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. [Comparative Study]. 2006;49(3):371–6.

    Google Scholar 

  27. Sehgal R, Koltun WA. Fibrin glue for the treatment of perineal fistulous Crohn’s disease. Gastroenterology. [Comment Editorial]. 2010;138(7):2216–9.

    Google Scholar 

  28. Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J, et al. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: A phase ii clinical trial. Dis Colon Rectum. [Clinical Trial, Phase II Multicenter Study Randomized Controlled Trial]. 2009;52(1):79–86.

    Google Scholar 

  29. Lee WY, Park KJ, Cho YB, Yoon SN, Song KH, Kim do S, et al. Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn’s fistula. Stem cells. [Research Support, Non-U.S. Gov’t]. 2013;31(11):2575–81.

    Google Scholar 

  30. Ciccocioppo R, Bernardo ME, Sgarella A, Maccario R, Avanzini MA, Ubezio C, et al. Autologous bone marrow-derived mesenchymal stromal cells in the treatment of fistulising Crohn’s disease. Gut. [Evaluation Studies Research Support, Non-U.S. Gov’t]. 2011;60(6):788–98.

    Google Scholar 

  31. Pardi DS, Loftus EV, Jr., Tremaine WJ, Sandborn WJ, Alexander GL, Balm RK, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc. [Clinical Trial]. 1999 Feb;49(2):153–7.

    Google Scholar 

  32. Rubin PH, Friedman S, Harpaz N, Goldstein E, Weiser J, Schiller J, et al. Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps. Gastroenterology. 1999;117(6):1295–300.

    Article  CAS  PubMed  Google Scholar 

  33. Hurlstone DP, Sanders DS, Atkinson R, Hunter MD, McAlindon ME, Lobo AJ, et al. Endoscopic mucosal resection for flat neoplasia in chronic ulcerative colitis: Can we change the endoscopic management paradigm? Gut. [Evaluation Studies Research Support, Non-U.S. Gov’t]. 2007;56(6):838–46.

    Google Scholar 

  34. Smith LA, Baraza W, Tiffin N, Cross SS, Hurlstone DP. Endoscopic resection of adenoma-like mass in chronic ulcerative colitis using a combined endoscopic mucosal resection and cap assisted submucosal dissection technique. Inflamm Bowel Dis. [Research Support, Non-U.S. Gov’t]. 2008t;14(10):1380–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Siddharth Singh MD

  2. Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 41041 Bioinformatics Boulevard, CB 7080, Chapel Hill, NC, 27599, USA

    Todd H. Baron Sr. MD

Authors
  1. Siddharth Singh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Todd H. Baron Sr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Siddharth Singh MD .

Editor information

Editors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA

    Richard Kozarek

  2. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA

    Michael Chiorean

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

    Michael Wallace

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

318160_1_En_21_MOESM1_ESM.mp4

Video demonstrates spontaneous drainage of perirectal abscess following balloon deflation. (MP4 39,042 kb)

Video demonstrates a second stricture that was dilated 12-13.5 mm followed by removal of upstream enteroliths. (MP4 120,944 kb)

Video 21.1

Video demonstrates spontaneous drainage of perirectal abscess following balloon deflation. (MP4 39,042 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Singh, S., Baron, T.H. (2015). Endoscopic Treatment of Complications of Inflammatory Bowel Diseases. In: Kozarek, R., Chiorean, M., Wallace, M. (eds) Endoscopy in Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-11077-6_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-11077-6_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-11076-9

  • Online ISBN: 978-3-319-11077-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation