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Endoscopic Treatment of Complications of Inflammatory Bowel Diseases

  • Siddharth SinghEmail author
  • Todd H. BaronSr.
Chapter
  • 1.3k Downloads

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.

Keywords

Stricture Fistula Glue Stent Endoscopic dilation Crohn’s disease Ulcerative colitis 

Supplementary material

318160_1_En_21_MOESM1_ESM.mp4 (38.1 mb)
Video 21.1 Video demonstrates spontaneous drainage of perirectal abscess following balloon deflation. (MP4 39,042 kb)
Video 21.2

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

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  2. 2.Division of Gastroenterology and HepatologyUniversity of North Carolina at Chapel HillChapel HillUSA

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