P0620Endoscopic ultrasound-guided enteroscopic treatment for small bowel stricture with enteroscope (with video)

Abstract Background Small bowel endoscopic stricturotomy is challenging with a high risk of bleeding and perforation. Prior to performing treatment for small bowel stricture, using a miniprobe small bowel ultrasound endoscope to evaluate the stricture, determine the type of stricture, and measure the thickness of the bowel wall can facilitate targeted stricturotomy, which means cutting at the thicker parts of the bowel wall. Methods Here, we demonstrate the use of small intestinal ultrasound endoscopy in small bowel stricturotomy. The video shows the process of performing an endoscopic ultrasound examination before treatment of a stricture, and the process of endoscopic stricturotomy. Results This is a 27-year-old patient with Crohn’s disease who underwent small bowel endoscopy to assess the therapeutic effect after standardized treatment. Double balloon enteroscopy detected a stricture in the ileum (Fig. 1), along with slight hyperemia of the mucosa around the stricture. No ulcers were noted, and the endoscope was prevented from advancing further. To evaluate the condition, a micro-probe small bowel ultrasound endoscopy (Endoscopic Ultrasound System IM-02P-202501, produced by InnerMedical Co., Ltd, Shenzhen, China) was initially performed (Fig. 2), which indicated thickening of the bowel wall, particularly in the submucosal layer, with a hyperechoic change in the submucosal layer, suggesting a fibrous stricture. The thickness of bowel wall was subsequently evaluated, revealing a uniform thickening. An IT knife was utilized to create an incision at any point of the stricture, and following this procedure, the small bowel endoscope navigated through the stricture with ease (Fig. 3). Ultimately, metal clips were employed to suture the wound (Fig. 4). The one-month postoperative follow-up indicated no bleeding or perforation in the patient. Conclusion In comparison to the absence of micro-probe small bowel ultrasound endoscopy, utilizing ultrasound endoscopy for evaluation proved to be the safer option. Conflict of interest: Mr. Liu, Zhongcheng: No conflict of interest Guo, Qin: No conflict of interest