Endoscopic radial incision and cutting for Crohn’s Disease-associated intestinal stricture: a pilot study

Background and study aims Intestinal stricture associated with Crohn’s disease (CD) is usually treated by endoscopic balloon dilation (EBD) or stricture plasty. Although EBD is effective and safe for such strictures, refractory stricture after EBD poses a problem. Hence, other novel approaches for these refractory strictures are required. On the other hand, the efficacy of radial incision and cutting (RIC) method for esophageal stricture after esophagogastric surgery is reported. In this pilot study, we adopted the RIC technique for five CD patients with refractory intestinal stricture to dilate their strictures. We conducted the RIC procedure using an electric needle knife with a ceramic tip on the top of the needle. Four cases were of anastomotic stricture after ileocecal resection and the remaining one case was of stricture due to mucosal healing. The RIC procedure was successful for all five patients. Average procedure time was 18.6 minutes. One patient developed delayed bleeding after RIC. There were no cases of perforation. RIC could be an alternative therapy for intestinal stricture associated with CD. Further studies should be conducted to clarify its efficacy and safety.

Making Qualitative Intestinal Stricture Quantitative: Embracing Radiomics in IBD

Quantifying intestinal fibrosis is an important but challenging issue in stricturing CD. With the advent of radiomics, MRE and CTE are highly minable data rather than merely pictures, which will greatly facilitate precision medicine in intestinal fibrosis of CD.

High circulating elafin levels are associated with Crohn’s disease-associated intestinal strictures

ObjectiveNearly 33% of Crohn’s disease (CD) patients develop intestinal strictures. Antimicrobial peptide or protein expression is associated with disease activity in inflammatory bowel disease (IBD) patients. Circulating blood cells and intestine of IBD patients have abnormal expression of elafin, a human elastase-specific protease inhibitor and antimicrobial peptide. However, the association between elafin and CD-associated intestinal stricture is unknown. We hypothesize the elafin expression in stricturing CD patients is abnormal. We determined the expression of elafin in blood, intestine, and mesenteric fat in IBD patients.MethodsHuman colonic and mesenteric fat tissues and serum samples were collected from the Cedars-Sinai Medical Center and UCLA, respectively.ResultsHigh serum elafin levels were associated with a significantly elevated risk of intestinal stricture in CD patients. Machine learning algorithm using serum elafin levels and clinical data identified stricturing CD patients with high accuracy. Serum elafin levels had weak positive correlation with clinical disease activity (Partial Mayo Score and Harvey Bradshaw Index) in IBD patients. Ulcerative colitis (UC) patients had high serum elafin levels, but the increase was not associated with endoscopic Mayo score. Colonic elafin mRNA and protein expression were not associated with clinical disease activity in IBD patients, while stricturing CD patients had low colonic elafin expression. Mesenteric fat in stricturing CD patients had significantly increased elafin mRNA expression, which may contribute to high circulating elafin level.ConclusionHigh serum elafin levels and adipose elafin expression are associated with intestinal strictures, which may help identify intestinal strictures in CD patients.