Small-Bowel Strictures Dilation and Stent Placement

  • Todd H. BaronEmail author


Small-bowel strictures are relatively uncommon and can be benign or malignant. Benign strictures are usually related to peptic ulcer disease and nonsteroidal anti-inflammatory agents. Balloon dilation can be performed safely with modest efficacy. Malignant strictures are usually due to pancreatic cancer and obstruction of the second duodenum. Self-expandable metal stents can be placed to relieve obstruction in such patients. Additionally, self-expandable stents can be placed more distally, although this requires the use of colonoscopes or enteroscopes. In this chapter balloon dilation and stent placement of small-bowel strictures will be discussed.


Small bowel Strictures Peptic ulcer Nonsteroidal anti-inflammatory drugs (NSAIDs) Balloon dilation Pancreatic cancer Duodenal obstruction Self-expandable metal stents (SEMS) Stent placement 

Supplementary material

Video 12.1

Placement of expandable metal stent in a patient with prior pyloric sparing Whipple and biliary obstruction. There is downstream obstruction due to recurrent tumor in the afferent limb. The stricture could not be traversed with biliary accessories using an adult colonoscope. The single balloon endoscope was advanced to the lesion and allowed an en face view of the stricture. It was then traversed. A guidewire and catheter were left in place. The adult colonoscope was then loaded over the wire and an enteral stent placed (MPG 54,670 kb)

Video 12.2

Placement of a WallFlex stent to open an ileal obstruction. Video courtesy of Louis M. Wong Kee Song, MD, at Mayo, Rochester (WMV 26,123 kb)

Video 12.3

Placement of a WallFlex stent to open a gastric outlet obstruction at the ligament of Treitz. Video courtesy of Louis M. Wong Kee Song, MD, at Mayo, Rochester (WMV 10,154 kb)


  1. 1.
    Chen M, Shen B. Ileoscopic balloon dilation of Crohn’s disease strictures via stoma. Gastrointest Endosc. 2014;79:688–93.PubMedCrossRefGoogle Scholar
  2. 2.
    ASGE Technology Committee, Siddiqui UD, Banerjee S, Barth B, Chauhan SS, Gottlieb KT, et al. Tools for endoscopic stricture dilation. Gastrointest Endosc. 2013;78:391–404.CrossRefGoogle Scholar
  3. 3.
    Hayashi Y, Yamamoto H, Yano T, Kitamura A, Takezawa T, Ino Y, et al. A calibrated, small-caliber tip, transparent hood to aid endoscopic balloon dilation of intestinal strictures in Crohn’s disease: successful use of prototype. Endoscopy. 2013;45(Suppl 2 UCTN):E373–4.PubMedGoogle Scholar
  4. 4.
    Hirai F, Beppu T, Takatsu N, Yano Y, Ninomiya K, Ono Y, et al. Long-term outcome of endoscopic balloon dilation for small bowel strictures in patients with Crohn’s disease. Dig Endosc. 2014;26:545–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Hirai F, Beppu T, Sou S, Seki T, Yao K, Matsui T. Endoscopic balloon dilatation using double-balloon endoscopy is a useful and safe treatment for small intestinal strictures in Crohn’s disease. Dig Endosc. 2010;22:200–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Manes G, Imbesi V, Ardizzone S, Cassinotti A, Pallotta S, Porro GB. Use of double-balloon enteroscopy in the management of patients with Crohn’s disease: feasibility and diagnostic yield in a high-volume centre for inflammatory bowel disease. Surg Endosc. 2009;23:2790–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Stienecker K, Gleichmann D, Neumayer U, Glaser HJ, Tonus C. Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn’s disease: a prospective study. World J Gastroenterol. 2009;15:2623–7.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Despott EJ, Gupta A, Burling D, Tripoli E, Konieczko K, Hart A, et al. Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn’s disease (with video). Gastrointest Endosc. 2009;70:1030–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Foster EN, Quiros JA, Prindiville TP. Long-term follow-up of the endoscopic treatment of strictures in pediatric and adult patients with inflammatory bowel disease. J Clin Gastroenterol. 2008;42:880–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Pohl J, May A, Nachbar L, Ell C. Diagnostic and therapeutic yield of push-and-pull enteroscopy for symptomatic small bowel Crohn’s disease strictures. Eur J Gastroenterol Hepatol. 2007;19:529–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Singh VV, Draganov P, Valentine J. Efficacy and safety of endoscopic balloon dilation of symptomatic upper and lower gastrointestinal Crohn’s disease strictures. J Clin Gastroenterol. 2005;39:284–9.PubMedCrossRefGoogle Scholar
  12. 12.
    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. 2007;5:1065–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Blanco-Rodríguez G, Penchyna-Grub J, Porras-Hernández JD, Trujillo-Ponce A. Transluminal endoscopic electrosurgical incision of fenestrated duodenal membranes. Pediatr Surg Int. 2008;24:711–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Kerkhof M, Dewint P, Koch AD, van der Woude CJ. Endoscopic needle-knife treatment of refractory ileo-ascending anastomotic stricture. Endoscopy. 2013;45(Suppl 2 UCTN):E57–8. doi: 10.1055/s-0032-1325973.PubMedGoogle Scholar
  15. 15.
    Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc. 2013;78:819–35.PubMedCrossRefGoogle Scholar
  16. 16.
    Baron TH. Expandable gastrointestinal stents. Gastroenterology. 2007;133:1407–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Chan AC, Shin FG, Lam YH, et al. A comparison study on physical properties of self-expandable esophageal metal stents. Gastrointest Endosc. 1999;49:462–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Silvis SE, Sievert Jr CE, Vennes JA, Abeyta BK, Brennecke LH. Comparison of covered versus uncovered wire mesh stents in the canine biliary tract. Gastrointest Endosc. 1994;40:17–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Bethge N, Sommer A, Gross U, von Kleist D, Vakil N. Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc. 1996;43:596–602.PubMedCrossRefGoogle Scholar
  20. 20.
    Eloubeidi MA, Lopes TL. Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans. Am J Gastroenterol. 2009;104:1374–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Small AJ, Petersen BT, Baron TH. Closure of a duodenal stent-induced perforation by endoscopic stent removal and covered self-expandable metal stent placement (with video). Gastrointest Endosc. 2007;66:1063–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Popa D, Ramesh J, Peter S, Wilcox CM, Mönkemüller K. Small bowel stent-in-stent placement for malignant small bowel obstruction using a balloon-assisted overtube technique. Clin Endosc. 2014;47:108–11.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Pérez-Cuadrado E, Carballo F, Latorre R, Soria F, López-Albors O. An endoscopic technique for treating symptomatic distal jejunum obstruction by leaving the overtube in place. Rev Esp Enferm Dig. 2013;105:107–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Espinel J, Pinedo E. A simplified method for stent placement in the distal duodenum: enteroscopy overtube. World J Gastrointest Endosc. 2011;3:225–7.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Ross AS, Semrad C, Waxman I, Dye C. Enteral stent placement by double balloon enteroscopy for palliation of malignant small bowel obstruction. Gastrointest Endosc. 2006;64:835–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Lennon AM, Chandrasekhara V, Shin EJ, Okolo 3rd PI. Spiral-enteroscopy-assisted enteral stent placement for palliation of malignant small-bowel obstruction (with video). Gastrointest Endosc. 2010;71:422–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Dormann A, Meisner S, Verin N, Wenk LA. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36:543–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Mittal A, Windsor J, Woodfield J, Casey P, Lane M. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg. 2004;91:205–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Gastroenterology & HepatologyUniversity of North Carolina, Chapel HillChapel HillUSA

Personalised recommendations