Endoscopic Stenting of J Pouch Crohn’s Stricture After Proctocolectomy

Ajit Pai, MCh, Jan P. Kaminski, MD, John J. Park, MD, Slawomir J. Marecik, MD, Leela M. Prasad, MD

Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA (Drs. Pai, Park, Marecik, and Prasad). Department of General Surgery, UIC Metropolitan Group Hospitals Residency Program, Chicago, IL, USA (Dr. Kaminski).

ABSTRACT

Introduction: Crohn’s stricture of the ileal J pouch is an important cause of pouch failure and a difficult condition to treat endoscopically. We seek to document the successful endoscopic treatment of fibrostenotic Crohn’s strictures of the afferent limb of the ileal J pouch in a typical patient.

Case and Technique Description: Endoscopic stenting of the strictured segment was performed with a special covered esophageal wall stent, with the technique being refined over multiple episodes of stenting. Ultimately, a partially covered nitinol double-flared esophageal stent led to the optimal outcome.

Discussion: Successful pouch salvage, good quality of life, and avoidance of ileostomy for the past 7 years were achieved. Endoscopic stenting is an important technique in the armamentarium of the surgeon and gastroenterologist to effectively treat fibrostenotic Crohn’s strictures of the ileoanal pouch and can successfully avoid the need for complex abdominal procedures, pouch takedown, and permanent ileostomy.

Key Words: J pouch, Proctocolectomy restorative, Crohn’s disease, Stricture, Stents.

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