Endoscopic Treatment of Stenosis of the Small Intestine

Stenosis of the small intestine found by endoscopy requires determining a treatment strategy. For stenosis associated with benign disease, it should be determined in principle whether the stenosis can be treated by endoscopic dilatation (see section 11.4). Although endoscopic dilatation of stenosis of the small intestine is believed to be an important procedure that will develop further, the risk of dilatation-related perforation should always be taken into consideration. For the establishment of indications for endoscopic dilatation, it should be determined which lesions can be treated safely by dilatation and whether dilatation is expected to provide long-term alleviation of clinical symptoms on the basis of accumulated clinical data. For stenosis of the small intestine associated with malignant disease, resection of the affected intestine is considered after the curability of the lesion is determined by whole-body screening. In some cases, however, intervention is limited to bypass surgery alone. Endoscopic stenting may be considered when long-term survival is unlikely, surgery under general anesthesia is difficult because of underlying disease, or patients refuse to undergo surgery (see section 11.4).

Images of stenosis in bowel obstruction of the small intestine caused by submucosal hematoma in a patient receiving an anticoagulant (anticoagulant bowel obstruction) (Fig. 10.3.1) [1].

Fig. 10.3.1. Anticoagulant bowel obstruction a Endoscopic view b Selective contrast-enhanced radiograph

Fig. 10.3.1. Anticoagulant bowel obstruction a Endoscopic view b Selective contrast-enhanced radiograph

Endoscopic dilatation of stenosis of the small intestine in a patient with Crohn's disease (Fig. 10.3.2) [2].

Small Intestine Fluoroscopic Images

Fig. 10.3.2. Jejunal stenosis due to Crohn's disease a Endoscopic view b Contrast-enhanced radiograph of stenosis before dilatation c Dilatation of stenosis with a balloon dilator inserted under fluoroscopic guidance after guidewire placement and endoscope removal. Arrows indicate strictures before dilatation; arrowheads indicate additional strictures at the distal site. d Endoscopic view after dilatation

Fig. 10.3.2. Jejunal stenosis due to Crohn's disease a Endoscopic view b Contrast-enhanced radiograph of stenosis before dilatation c Dilatation of stenosis with a balloon dilator inserted under fluoroscopic guidance after guidewire placement and endoscope removal. Arrows indicate strictures before dilatation; arrowheads indicate additional strictures at the distal site. d Endoscopic view after dilatation b a c

■ References

1. Shinozaki S, Yamamoto H, Kita H, et al (2004) Case report: direct observation with double-balloon enteroscopy of an intestinal intramural hematoma resulting in anticoagulant ileus. Dig Dis Sci 49:902-905

2. Sunada K, Yamamoto H, Kita H, et al (2004) Case report: successful treatment with balloon dilatation in combination with double-balloon enteroscopy of a stricture in the small bowel of a patient with Crohn's disease. Dig Endosc 16:237-240

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