Endoscopic Management of Crohn’s Disease Strictures

Crohn’s disease is a chronic, progressive inflammatory condition characterised by gastrointestinal tract inflammation and extra-intestinal manifestations. Some patients may develop stricturing disease, which may either be of inflammatory, fibrotic or post-anastamotic aetiologies. The management of fibrostenosis is challenging, necessitating preventative strategies and a multidisciplinary approach to its diagnosis and management once established. Although several treatment options are currently used in the management of strictures, there are currently no targeted anti-fibrotic therapies. Endoscopically, there are several modalities that can be employed in the symptomatic patient including balloon dilatation and stenting. In this article we will briefly discuss the pathophysiology and investigations with focus centred around endoscopic management of Crohn’s strictures, before suggesting a strategy to employ when approaching these cases.