A 34-year old man had been diagnosed with Crohn’s disease over 3 years ago and had received biologic agents and enteral nutrition. Colonoscopy had shown stricture of the ileocecal orifice, and endoscopic balloon dilation had been performed on this 3 months ago. On his current presentation for reexamination, colonoscopy again showed stricture of the ileocecal orifice ( Fig. 1 ) with multiple nodular hyperplastic polyps covering the area around the orifice ( Fig. 2 ). Snare polypectomy was first done until the orifice appeared, then an IT2 knife was used to perform stricturotomy. The stricturotomy successfully dilated the stricture ( Fig. 3 ), and as for the remaining polyps we decided to “trim” them with the electrical snare to improve the appearance of the ileocecal valve ( Fig. 4 ); the procedure is called ileocecal valve-plasty ( Video 1 ).
Fig. 1.
Colonoscopy showed stricture of the ileocecal orifice.
Fig. 2.
Multiple nodular hyperplastic polyps covered the area around the orifice.
Fig. 3.
Stricturotomy was successfully performed after snare polypectomy of some of the polyps.
Fig. 4.
To improve the appearance of the ileocecal valve, the remaining nodular hyperplastic polyps were resected with an electrical snare.
Video 1 Ileocecal valve-plasty in a patient with Crohn’s disease.
We have performed ileocecal valve-plasty in 6 similar cases before (5 were ileocecal valve strictures and 1 was an anastomotic stricture, and in 1 case snare polypectomy was done before dilation). No adverse events occurred in these cases. Follow-up after the procedure showed recurrent stricture in 2 patients, while 1 patient had no recurrence in 65 months. One patient was lost to follow-up, and the rest had their procedures performed recently.
It is important to select appropriate cases for this endoscopic plasty. The plasty can be performed in two ways: (i) polypectomy after dilation or stricturotomy to make the intestine look better and perhaps help reduce recurrence; (ii) polypectomy before dilation or stricturotomy to facilitate the latter procedure.
Endoscopy_UCTN_Code_CCL_1AC_2AD
Footnotes
Competing interests The authors declare that they have no conflict of interest.
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