Endoscopic intralesional platelet-rich plasma (PRP) injection after balloon dilation for colonic Crohn’s disease strictures: a pilot study

Abstract Background and Aims: Fibrostenotic strictures complicate Crohn's disease (CD) and often recur after endoscopic balloon dilation (EBD). Platelet-rich plasma (PRP) promotes wound healing in other fibroproliferative disorders, but its endoscopic application in CD stricture has not been explored. We aimed to assess the safety, feasibility, and preliminary efficacy of intralesional PRP injection after EBD for colonic CD strictures. Methods: This was a prospective, single-arm pilot study. Between January 2024 and August 2025, 29 patients with colonic CD strictures underwent EBD followed by submucosal injection of autologous PRP (1-2 mL at 3-4 points of the dilated segment). The primary outcome was the restenosis rate at 3 weeks, defined as inability to pass a 10.5-mm endoscope. Secondary outcomes included technical success, adverse events, changes in intestinal ultrasound findings, and the proportion of patients requiring surgery within 1 year. Results: Technical success was achieved in 100% of patients (29/29). No PRP-related adverse events occurred. Two patients (6.9%) developed delayed hemorrhage attributable to concurrent polypectomy rather than PRP injection, and one patient (3.4%) developed a perforation related to balloon dilation that was successfully managed with endoscopic clip closure. The restenosis rate was 48.2% at the 3-week follow-up and 73.1% at 1 year. Intestinal ultrasound showed no significant changes from baseline in stricture-wall thickness or proximal luminal width at either time point. At 1 year, one patient (3.8%) underwent surgery due to perforation. Conclusions: Endoscopic intralesional PRP injection after EBD is technically feasible and safe in colonic CD strictures. Although this single-arm study cannot establish efficacy, it provides the first descriptive benchmark of restenosis outcomes with this approach; the favorable safety profile supports further investigation of repeated dosing or combination strategies in this and other fibrostenotic conditions.