Enteroscopy-Guided Cutting Dilatation: An Effective Alternative for Managing Benign Small Bowel Strictures

Aims Endoscopic dilatation is a less invasive alternative to surgery for small bowel strictures associated with Crohn's disease. This study aimed to evaluate the efficacy and safety of cutting dilatation using double balloon enteroscopy (DBE) for these strictures and assess its potential as an alternative to endoscopic balloon dilatation.

Methods This retrospective study included patients diagnosed with benign small bowel strictures who underwent DBE over the past five years. A total of 29 symptomatic patients with small bowel strictures (26 with Crohn's disease and 3 with NSAID-induced enteropathy) received balloon or cutting dilatation. Patients were followed for at least six months. Clinical success was defined as the resolution of obstructive symptoms, and technical success was defined by successful passage of the scope.

Results : Among the cases, 12 (38.7%) had single lesions, while 17 (54.8%) had multiple strictures. Inflammatory strictures were observed in 15 cases (48.4%), and fibrotic strictures in 14 cases (45.2%). Balloon dilatation alone was performed in six cases (19.4%) with a technical failure in two cases. Cutting dilatation alone was performed in 13 cases (41.9%), achieving technical success in 92.3% (12/13). In the combined therapy group, patients with multiple strictures achieved a 100% success rate (10/10), while the success rate of balloon dilatation for secondary strictures was 30% (3/10). One perforation (3.2%) occurred during balloon dilatation. Long, inflammatory strictures were significant risk factors for the failure of cutting dilatation (p<0.05).

Conclusions : Endoscopic cutting dilatation appears to be a safe and effective treatment alternative for small bowel strictures and may serve as an alternative or complement to balloon dilatation, particularly in cases with long-segment strictures. Further studies are warranted to optimize patient selection and treatment protocols.

Publication History

Article published online:
27 March 2025