Ileocecal valve-plasty for Crohn’s disease: an endoscopic approach

A 34-year old man had been diagnosed with Crohn’s disease over 3 years ago and had received biologic agents and enteral nutrition. Colonoscopy had shown stricture of the ileocecal orifice, and endoscopic balloon dilation had been performed on this 3 months ago. On his current presentation for reexamination, colonoscopy again showed stricture of the ileocecal orifice ([Fig. 1]) with multiple nodular hyperplastic polyps covering the area around the orifice ([Fig. 2]). Snare polypectomy was first done until the orifice appeared, then an IT2 knife was used to perform stricturotomy. The stricturotomy successfully dilated the stricture ([Fig. 3]), and as for the remaining polyps we decided to “trim” them with the electrical snare to improve the appearance of the ileocecal valve ([Fig. 4]); the procedure is called ileocecal valve-plasty ([Video 1]).

Fig. 1 Colonoscopy showed stricture of the ileocecal orifice.

Fig. 2 Multiple nodular hyperplastic polyps covered the area around the orifice.

Fig. 3 Stricturotomy was successfully performed after snare polypectomy of some of the polyps.

Fig. 4 To improve the appearance of the ileocecal valve, the remaining nodular hyperplastic polyps were resected with an electrical snare.

Video 1 Ileocecal valve-plasty in a patient with Crohn’s disease.

We have performed ileocecal valve-plasty in 6 similar cases before (5 were ileocecal valve strictures and 1 was an anastomotic stricture, and in 1 case snare polypectomy was done before dilation). No adverse events occurred in these cases. Follow-up after the procedure showed recurrent stricture in 2 patients, while 1 patient had no recurrence in 65 months. One patient was lost to follow-up, and the rest had their procedures performed recently.

It is important to select appropriate cases for this endoscopic plasty. The plasty can be performed in two ways: (i) polypectomy after dilation or stricturotomy to make the intestine look better and perhaps help reduce recurrence; (ii) polypectomy before dilation or stricturotomy to facilitate the latter procedure.

Endoscopy_UCTN_Code_CCL_1AC_2AD

Publication History

Article published online:
10 May 2023