Therapeutic Armamentarium for Stricturing XXXX : Medical Versus Endoscopic Versus Surgical Approaches.

@entity1 @entity75 @entity384 @entity5 @entity30 @entity1744
One-third of @entity1 with @entity30 ( @entity30 ) present as stricturing phenotype characterized by progressive luminal narrowing and obstructive symptoms. The diagnosis and management of these @entity1 have been intriguing and challenging. Immunomodulators and biologics have been successfully used in treating inflammatory and fistulizing @entity30 . There are issues of efficacy and safety of biological agents in treating strictures in @entity30 . Rapid mucosal healing from potent biological agents may predispose @entity1 to the development of new strictures or worsening of existing strictures. On the other hand, strictures constitute one-fifth of the reasons for surgery in @entity1 with @entity30 . Disease recurrence is common at or proximal to the anastomotic site with the majority of these @entity1 developing new @entity75 within 1 year of surgery. The progressive nature of the disease with repetitive cycle of inflammation and stricture formation results in repeated surgery, with a risk of @entity1744 . There is considerable quest for bowel conserving endoscopic and surgical strategies. @entity384 and stricturoplasty have emerged as valid alternatives to resection. @entity384 has been shown to be feasible, safe, and effective for the short primary or anastomotic strictures. However, repeated dilations are often needed, and long-term outcomes of @entity384 remain to be investigated. The introduction of stricturoplasty has added another dimension to bowel saving strategy. Although postoperative recurrence rate after stricturoplasty is comparable with surgical resection, there are concerns for increased risk of @entity5 in preserved bowel. Laparoscopic surgery has widely been performed with similar outcomes to open approach with fewer complications, quicker recovery, better cosmesis, and lower cost. All of these issues should be considered by physicians involved in the management of @entity1 with stricturing @entity30 .
