DOI QR코드

DOI QR Code

Endoscopic Diagnosis and Treatment of Benign Small Bowel Stricture

양성 소장협착의 내시경적 진단과 치료

  • Jinsu Kim (Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 김진수 (가톨릭대학교 의과대학 은평성모병원 소화기내과)
  • Received : 2024.07.14
  • Accepted : 2024.07.17
  • Published : 2024.08.01

Abstract

Benign small bowel strictures can occur in association with various conditions, including small bowel Crohn's disease, nonsteroidal anti-inflammatory drug-induced enteritis, ischemic enteritis, intestinal tuberculosis, radiation enteritis, postoperative adhesions, and anastomotic strictures. Benign small bowel strictures are classified into two categories, low-grade and high-grade. Low-grade small bowel strictures involve a partial reduction of the internal diameter of the small intestine, causing slight obstruction of the passage of food and digestive fluids without significant bowel obstruction symptoms. By contrast, high-grade small bowel strictures involve a severe narrowing of the intestinal lumen, leading to marked obstruction of the passage of food and digestive fluids and pronounced bowel obstruction symptoms. Small bowel strictures can be diagnosed using various methods, including abdominal plain radiography, abdominal computed tomography, computed tomography enterography, magnetic resonance enterography, balloon-assisted enteroscopy, and abdominal ultrasound. Each diagnostic method has unique advantages and disadvantages as well as differences in diagnostic specificity and sensitivity. Therefore, even if small bowel strictures are not observed using a single imaging technique, their presence cannot be completely excluded. A comprehensive diagnosis that combines clinical information from multiple diagnostic modalities is necessary. Therapeutic approaches for managing small bowel strictures include medical therapy, endoscopic balloon dilation using balloon-assisted enteroscopy, and surgical methods such as strictureplasty and segmental resection. Endoscopic balloon dilation, in particular, can help reduce complications associated with repeated surgeries for strictures.

Keywords

References

  1. Durmush D, Kaffes AJ. Small bowel strictures. Curr Opin Gastroenterol 2019;35:235-242. https://doi.org/10.1097/MOG.0000000000000531
  2. Baars JE, Theyventhiran R, Aepli P, Saxena P, Kaffes AJ. Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: a systematic review. World J Gastroenterol 2017;23:8073-8081. https://doi.org/10.3748/wjg.v23.i45.8073
  3. Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC. Current concepts in imaging of small bowel obstruction. Radiol Clin North Am 2003;41:263-283. https://doi.org/10.1016/S0033-8389(02)00114-8
  4. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn's disease complicated by strictures: a systematic review. Gut 2013;62:1072-1084. https://doi.org/10.1136/gutjnl-2012-304353
  5. Dietrich CF. Significance of abdominal ultrasound in inflammatory bowel disease. Dig Dis 2009;27:482-493. https://doi.org/10.1159/000233287
  6. Park SH, Kim YJ, Rhee KH, et al. A 30-year trend analysis in the epidemiology of inflammatory bowel disease in the Songpa-Kangdong district of Seoul, Korea in 1986-2015. J Crohns Colitis 2019;13:1410-1417. https://doi.org/10.1093/ecco-jcc/jjz081
  7. Mensink PB, Groenen MJ, van Buuren HR, Kuipers EJ, van der Woude CJ. Double-balloon enteroscopy in Crohn's disease patients suspected of small bowel activity: findings and clinical impact. J Gastroenterol 2009;44:271-276. https://doi.org/10.1007/s00535-009-0011-4
  8. May A, Farber M, Aschmoneit I, et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with smallbowel disorders. Am J Gastroenterol 2010;105:575-581. https://doi.org/10.1038/ajg.2009.712
  9. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 2011;140:1785-1794. https://doi.org/10.1053/j.gastro.2011.01.055
  10. Navaneethan U, Lourdusamy V, Njei B, Shen B. Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc 2016;30:5434-5443. https://doi.org/10.1007/s00464-016-4902-1
  11. Yamamoto H, Yano T, Araki A, et al. Guidelines for endoscopic balloon dilation in treating Crohn's disease-associated small intestinal strictures (supplement to the clinical practice guidelines for enteroscopy). Dig Endosc 2022;34:1278-1296. https://doi.org/10.1111/den.14429
  12. Fukumoto A, Tanaka S, Yamamoto H, et al. Diagnosis and treatment of small-bowel stricture by double balloon endoscopy. Gastrointest Endosc 2007;66 Suppl 3:S108-S112. https://doi.org/10.1016/j.gie.2007.02.027
  13. Sunada K, Shinozaki S, Nagayama M, et al. Long-term outcomes in patients with small intestinal strictures secondary to crohn's disease after double-balloon endoscopy-assisted balloon dilation. Inflamm Bowel Dis 2016;22:380-386. https://doi.org/10.1097/MIB.0000000000000627
  14. Hirai F, Andoh A, Ueno F, et al. Efficacy of endoscopic balloon dilation for small bowel strictures in patients with Crohn's disease: a nationwide, multi-centre, open-label, prospective cohort study. J Crohns Colitis 2018;12:394-401. https://doi.org/10.1093/ecco-jcc/jjx159
  15. Bettenworth D, Bokemeyer A, Kou L, et al. Systematic review with meta-analysis: efficacy of balloon-assisted enteroscopy for dilation of small bowel Crohn's disease strictures. Aliment Pharmacol Ther 2020;52:1104-1116.  https://doi.org/10.1111/apt.16049