Cholangioscope-assisted evaluation and endoscopic incision of stricture caused by thick mucosal bridge in Crohn’s disease

Cholangioscope-assisted evaluation and endoscopic incision of stricture caused by thick mucosal bridge in Crohn's disease A 32-year-old man with an 8-year history of Crohn's disease (Montreal classification A2, L3, B2 p) presented with recurrent abdominal pain.After regular treatment with ustekinumab for 3 years, recent computed tomography revealed severe stricture in the ascending colon ( Fig. 1), and colonoscopy showed colorectal mucosal healing.However, two tiny holes were observed and could not be passed by the colonoscope ( Fig. 2).In order to find out which hole was the real narrow bowel lumen and to exclude a potential fistula, a cholangioscope (eye-MAX, 9 F; Micro-Tech, Nanjing, China) was inserted into the two holes respectively to gain direct views inside and behind the holes ( Fig. 3) [1,2].Amazingly, the ileocecal valve was reached by the cholangioscope through both holes, and superficial ulcer in the inner wall of the holes and multiple scar changes in the ileocecal region were observed simultaneously ( Fig. 4).The cholangioscopy result indicated that the stricture was caused by a rare thick mucosal bridge E-VideosVideo 1 Cholangioscopy-assisted evaluation and targeted treatment for Crohn's disease-associated stricture.