Safety and efficacy of strictureplasty for primary proximal duodenal Crohn’s disease: a retrospective single-center case series

Primary proximal duodenal Crohn's disease (CD) is a rare entity that can lead to fibrotic strictures and gastric outlet obstruction. Surgical intervention is often required in refractory cases, yet the optimal approach remains debated. This study aimed to evaluate the safety and efficacy of strictureplasty in this context. We retrospectively reviewed patients with primary proximal duodenal stricturing CD who underwent strictureplasty at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 2014 to December 2024. Data on demographics, preoperative characteristics, surgical techniques, and postoperative outcomes were collected and analyzed descriptively. Twenty-two patients were included, with a median age of 29.5 years (IQR: 24.75-33.75), and 81.8% were male. A laparoscopic-assisted approach was feasible in 86.4% of patients, and the Heineke-Mikulicz technique was used in 81.8%. Postoperative complications occurred in 18.2% (4/22), including transient gastroparesis (13.6%, n = 3) and one repair-site leak (4.5%, n = 1). During a median follow-up of 2.8 years, no reoperations for duodenal stenosis were required, and endoscopic evidence of recurrent duodenal lesions was observed in 2 of 21 evaluable patients. In this retrospective single-center case series, strictureplasty was associated with acceptable postoperative morbidity and satisfactory mid-term outcomes in selected patients with primary proximal duodenal stricturing CD. It may represent a feasible bowel-sparing option when carefully applied, although larger prospective studies are warranted.