Endoscopic needle-knife stricturoplasty in Esophageal Crohn's Disease – Case report

Background: Crohn's disease of the esophagus is rare, but if present, it may cause stricture of the involved parts. Even though the primary therapeutic intervention is endoscopic balloon dilation, some patients with refractory strictures require surgical resection. However radial electroincision of refractory esophagogastric anastomotic stricture after surgery is mentioned, Crohn's disease related needle-knife stricturoplasty is not known in the literature. Case report: A 64 years old female patient was diagnosed with buccal and esophageal manifestation of Crohn's disease 5 years ago. No other part of the gastrointestinal tract was involved. Balloon dilation was performed in 2010 and 2011. She was admitted to our gastroenterology department in May 2014 with relapsing dysphagy. The former buccal ulcers scarred, while in the esophagus a ring-like stricture was revealed starting at 20 cm from incisors. The next 10 cm was narrowed by pseudopolyps without active ulceration. We used needle knife to perfom three radial incisions at the level of the ring. One incision was clipped thereafter due to its deepness. The patient was discharged some days later. After 10 months of follow-up the patient was symptom-free, the gastroscopy revealed a tight ring with easy passage of the scope. Conclusion: In case of ring-like fibrotic stricture of the esophagus caused by Crohn's disease beside balloon dilation, the needle knife incision can be useful method to reveal the symptoms for a long-term duration.