Multidisciplinary management of gastrointestinal fibrotic stenosis in Crohn's disease.
Crohn's disease (CD) is a chronic inflammatory bowel disease that can involve virtually any part of the gastrointestinal tract. CD complications are the main indications for surgery. A large proportion of these interventions are due to stricturing disease. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD. Unfortunately, surgery is not curative, as the disease ultimately reoccurs in a substantial subset of patients. To best identify the patients who will require a specific treatment and to plane the most appropriate therapeutic approach, it is important to precisely define the type, the size, and the location of CD stenosis. Diagnostic approaches aim to distinguish fibrotic from inflammatory strictures. Medical therapy is required for inflammatory stenosis. Mechanical treatments are required when fibrotic CD strictures are symptomatic. The choice between endoscopic balloon dilation, stricturoplasty, and laparoscopic or open surgery is based on the presence of perforating complications, the remaining length of small bowel, and the number and length of strictures. The non-hierarchical decision-making process for the treatment of fibrotic CD therefore requires multidisciplinary clinical rounds with radiologists, gastroenterologists, interventional endoscopists, and surgeons.
Department of Surgery, Laiboisiere Hospital, Paris 7 University and AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France, bricemalgras@hotmail.com.
Brice
B
Malgras
Karine
K
Pautrat
Xavier
X
Dray
Pierre
P
Pasquier
Patrice
P
Valleur
Marc
M
Pocard
Philippe
P
Soyer
D000818:Animals; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003952:Diagnostic Imaging / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D005355:Fibrosis; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010348:Patient Care Team; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents