Abstract Background Ileocecal valve strictures complicated by pseudopolyps are sometimes deemed endoscopically inaccessible in Crohn’s disease (CD). We previously proposed “ileocecal valve-plasty” (ICVP) that first resects obstructing polypoid hyperplasia to expose the orifice (Figure 1). This paired, retrospective study compared the efficacy and safety of ICVP with traditional endoscopic balloon dilation (EBD)/stricturotomy alone. Methods CD patients with fibrotic valve strictures and pseudopolyps and received ICVP were enrolled (from 2014 to 2024). CD patients with fibrotic valve strictures and pseudopolyps who underwent traditional EBD/stricturotomy without polypectomy were 1:1 matched by sex, stricture length10mm, and number of pseudopolyps ≥5. Primary outcome was stricture-free survival (SFS); secondary outcomes were technical success, adverse events and surgery rate. Results A total of 34 patients (mean age 27.8±6.8 years, 28 males) with fibrotic ileocecal valve strictures and polypoid hyperplasia were enrolled, and each group had 17 patients. The two groups had no significant difference in age, gender distribution, body mass index (BMI), Harvey-Bradshaw Index (HBI), and Simple Endoscopic Score for Crohn’s Disease (SES-CD). There was no significant difference in the proportion of patients with ≥5 pseudopolyps between the two group (82.4% VS 47.1%, P = 0.071). The mean length of the stricture was longer in the ICVP group (21.8±5.0mm VS 17.4±6.4mm, P = 0.032). The mean diameter of the stricture was 2.9±2.2mm, with no difference between the two groups. Among all the patients, 26 (76.5%) patients received EBD, 7 (20.6%) patients received stricturotomy, and in one patient (2.9%), only polypectomy was performed as the ileocecal valve orifice became fully patent and allowed passage of the endoscope after polypectomy, further dilation or incision was deemed unnecessary.The technical success rate was 94.1%. Four patients in the ICVP group had hemorrhage after the procedure and needed endoscopic hemostasis. During a median follow-up of 131 weeks, the Kaplan‒Meier survival curves showed that the SFS had no significant differences between the two groups (P = 0.294). The 1-year SFS in the ICVP and the control group was 40% (95%CI 15.3%-64.7%) and 43.2% (95% CI 16.0%-70.4%), respectively. One patient in the ICVP group received ileocecal resection and partial ileal resection due to stricture. Conclusion ICVP safely converts anatomically unfavorable strictures into endoscopically treatable lesions by removing the “visual barrier” of pseudopolyps, which might help in postponing or averting surgery. Prospective multicentered validation with risk stratification is warranted. References: 1. Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, Ma C, Panés J, Rimola J, Fletcher JG, et al. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019;68:1115-1126. 2. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: a systematic review. Gut. 2013;62:1072-1084. 3. Ladrón Abia P, Alonso N, Mínguez Sabater A, Gimeno Torres M, Bastida G, Aguas M, Beltrán B, Sáez-González E, Pons V, Nos P, et al. The characteristics of the stricture, but not the ongoing treatment, could influence the outcome of endoscopic dilation in recurrent Crohn’s disease. Gastroenterol Hepatol. 2022;45:614-620. 4. Lu Y, Huang L, Sun J. Ileocecal valve-plasty for Crohn’s disease: an endoscopic approach. Endoscopy. 2023;55:E719-E720. Conflict of interest: Lu, Yi: Zhang, Qi: No conflict of interest Sun, Jiachen: No conflict of interest Zhi, Min: No conflict of interest
Lu et al. (Thu,) studied this question.