TABLE 4.
Cutting‐edge breakthroughs in the management of strictures in 2023.
| Treatment | Application scenario/pharmacodynamics mechanism | Reference | |
|---|---|---|---|
| Endoscopic Management | ES | Non‐fistulizing patients with anastomotic strictures; stenosis accompanied by ulcers | Jia Y, et al 73 |
| EBD | Patients with IPAA | Darlington K, et al 74 | |
| BAE‐based ES | Deep small bowel strictures | Ning SB, et al 75 | |
| Surgery | Surgery | Strictures persist despite endoscopic interventions or when there is significant obstruction | Senior K. 76 |
| Laparoscopic ileocecal resection | Limited involvement (affected segment ≤40 cm) and predominantly inflammatory terminal ileitis. | Popivanov G, et al 77 | |
| Ileocolonic resection | Anastomotic configuration, temporary diversion at the time of ileocolonic resection do not increase risk of anastomotic stricturing | Bachour SP, et al 78 | |
| Surgery | Surgery yields a lower re‐interventions rate compared with endotherapy | Pal P, et al 79 | |
| Drug | D‐ceo2 | Suppressing the expression of fibrosis‐related genes, specifically α‐SMA and Collagen 1/3; Reversing the activation of fibroblasts induced by TGF‐β1 | Cao Y, et al 80 |
| Fraxinellone | Inhibiting TGF‐β‐induced fibrosis responses by disrupting the TGF‐β/Smad2/3 signaling pathway and interfering with the interaction between HSP47 and collagen. | Wang J, et al 81 | |
| sEVs | Anti‐inflammatory oxylipins in sEVs prevent inflammation and fibrosis. | Gómez‐Ferrer M, et al 82 | |
| MSCs | Allogenic bone marrow‐derived MSCs | When injected with MSCs, some patients showed resolution of the stricture at week 12, and some achieved complete resolution at week 48. | Didamoony MA, et al 83 |
| hucMSC‐Ex | HucMSC‐Ex reduced inflammation‐induced fibrosis in mouse models, and inhibited fibroblast proliferation and migration through inhibiting ERK phosphorylation. | Wang Y, et al 23 | |
Abbreviations: BAE‐based ES, Balloon‐assisted enteroscopy‐based endoscopic stricturotomy; CD, Crohn’s disease; D‐CeO2, dextran‐coated cerium oxide; EBD, endoscopic balloon dilation; ES, endoscopic strictureplasty; FCSEMS, self‐expandable metal stent; HSP, heat shock protein; hucMSC‐Ex, human umbilical cord mesenchymal stem cell‐derived exosomes; IPAA, ileoanal and rectal strictures following ileal pouch‐anal anastomosis; MSCs, Mesenchymal stem cells; sEVs, human milk‐derived small extracellular vesicles; TGF‐β, transform growth factor‐β; WT1, Wilms tumor 1; α‐SMA, α‐smooth muscle actin.