Double balloon (push-and-pull) enteroscopy: breakthrough in the management of small intestinal strictures in Crohn's disease?

Development of strictures is common in Crohn's disease, leading to resective surgery in many cases. Endoscopic balloon dilation has been used alternatively, to treat short fibrotic strictures to avoid resection. Although the small bowel is a predominant site of strictures in Crohn's disease, endoscopic access had been limited. With the advent of double balloon (push-and-pull) enteroscopy, visualization of small intestinal stenoses has become possible. In the case of short fibrotic strictures hydrostatic balloon dilation can be performed. Pohl et al. report in this issue (Eur J Gastroenterol Hepatol 19:529-534) a first series of patients with suspected small bowel strictures that were confirmed by double balloon enteroscopy. Hydrostatic balloon dilation was feasible and safe in selected patients with short fibrotic stenosis, favorable anatomy and absence of severe inflammation. After dilation, nearly half of the patients had a clinical benefit without need for surgery after 10 months. On the basis of encouraging results of this first series, future studies will have to show general feasibility, safety and long term outcomes in larger cohorts.