Endoluminal Stenting for Long Term Management of Crohn’s Ileoanal Pouch Stricture

Fibrostenotic strictures are a challenging complication of Crohn’s disease, particularly when involving the ileal pouch-anal anastomosis (IPAA) in patients with misdiagnosed ulcerative colitis. We present a rare case of a 70-year-old male with Crohn’s disease-related afferent limb strictures following IPAA, successfully managed with endoscopic self-expanding metal stents over more than a decade. Initially treated with a fully covered stent, subsequent replacements with partially covered stents improved stability and reduced complications. Long-term follow-up demonstrated effective symptom control, preserved pouch function, and avoidance of permanent ileostomy. While early management required frequent interventions, the current stent has remained functional for nearly five years. Complications such as bleeding, migration, and mucosal ulceration were managed non-surgically. This case highlights the potential for endoscopic stenting to serve as a durable, organ-preserving alternative to surgery in complex Crohn’s presentations and represents the longest reported use of stenting in this context, warranting further investigation.