Endoscopic and Radiological Outcomes of Strictureplasty in Patients With Small Bowel Stricturing Crohn's Disease

PURPOSE: Endoscopic and radiologic changes following strictureplasty for Crohn's disease (CD) remain largely unknown. This study aimed to evaluate postoperative mucosal and transmural healing at strictureplasty sites. METHODS: A retrospective cohort study using a prospectively maintained database of patients undergoing surgery for small-bowel stricturing CD between October 2014 and January 2024 was conducted. Propensity score matching was performed to generate a contextual comparison group of patients undergoing intestinal resection. Endoscopic and radiological outcomes were evaluated using postoperative computed tomography enterography (CTE) and enteroscopy. RESULTS: 59 patients undergoing strictureplasty were included. Postoperative endoscopy showed mucosal healing at the primary strictureplasty site in 46 of 59 patients (78%, Median follow-up 8 months). CTE showed a marked reduction in bowel wall thickness compared to preoperative measurements (8.25 mm vs. 5.6 mm, p < 0.001) (Median follow-up 7 months). At the final follow-up (median follow-up 12 months), clinical recurrence requiring treatment escalation, was observed in 38/51 (75%) patients, and 23 (61%) of these recurrences were due to new sites rather than the strictureplasty site. No statistically significant difference in clinical recurrence was observed between the strictureplasty and matched resection cohorts (p = 0.74). CONCLUSIONS: Significant mucosal and transmural healing occurred at the site of the primary stricture within approximately 1 year of strictureplasty. Preservation of diseased bowel did not appear to increase short-term clinical recurrence in this cohort.