Background: Surgical resection of Crohn’s strictures refractory to medical management can lead to progressive re-stricturing and gastrointestinal tract shortening. In the adult population, there is evidence for endoscopic balloon dilatation and stenting, which can avoid the need for resection. In the paediatric population, there is some evidence for endoscopic balloon dilatation, very little for stenting in general, and none published on biodegradable stenting. We report the indication and outcome of dilatation (in three patients) with biodegradable stenting (in two patients) in the management of medically refractory Crohn’s strictures.
Case Description: Three paediatric patients with Crohn’s strictures refractory to medical management in one tertiary centre were treated. One patient had a tight duodenal stricture (D2) which was successfully treated with dilatations from 4mm to 15mm over a three-month period and twelve months later accepts an 18mm balloon. Two patients had rectosigmoid strictures, one post an anterior resection that leaked. Both underwent balloon dilatation, but on re-stricturing, had placement of biodegradeable stents [Carefusion ®]( Figure 1). One patient (post leak and covering ileostomy) has required three stents but is now three years post ileostomy closure and the stricture remains open. The other patient’s stricture was dilated from 4mm to 18mm and, one year post stent insertion, is still patent and has avoided stoma formation.
Conclusions: These cases demonstrate preliminary evidence for dilatation and biodegradable stents in paediatric Crohn’s strictures, with this being the first description of biodegradable stenting in the literature. We suggest these techniques may prove effective in delaying or even preventing resection in children with Crohn’s strictures.
Figure 1 – On table image intensifier image showing placement of stent.