Lumen-Apposing Metal Stent as a Bridge to Endoscopic Balloon Dilation for a Refractory Ileocolonic Anastomotic Crohn's Stricture

Abstract Strictures in Crohn's disease frequently involve ileocolonic anastomoses and may cause recurrent small bowel obstruction (SBO). Endoscopic balloon dilation (EBD) is effective but can be limited in complex strictures, and many patients ultimately require surgery. We report a 76-year-old man with long-standing stricturing/penetrating ileocolonic Crohn's disease and multiple resections who presented with recurrent SBO from a severely angulated, ulcerated pinhole-size ileocolonic anastomoses stricture not amenable to EBD. Given his age, frailty, and concern for further bowel loss that would result from additional surgery, we placed fully covered lumen-apposing metal stents endoscopically and removed it after 3 months, followed by staged EBD. This approach resulted in sustained symptom resolution and improved anastomotic patency without recurrent SBO up to 2 years.