Duodenal stricture with GOO: dilation or bypass first

endoscopic balloon dilation is the usual first-line approach for short, straight, accessible, non-penetrating benign duodenal strictures, with high technical success and moderate short-term symptom relief, but repeat dilations are often needed ^1,2. surgery provides more durable symptom control and longer recurrence-free survival than dilation in comparative duodenal Crohn’s data, at the cost of more post-procedural adverse events ². ^1,2

What is known:

• Balloon dilation achieved 97.4% technical success and 77.8% clinical success in a benign duodenal stenosis cohort. ¹
• eBD is limited to strictures that are straight, non-angulated, up to 5 cm, and endoscopically reachable. ¹
• A retrospective duodenal-stricture comparison found better symptomatic improvement and longer recurrence-free survival with surgery than with eBD. ²

What is unknown / caveats:

• The direct surgery-versus-eBD comparison cited is retrospective and from Crohn’s duodenal disease, not all benign duodenal strictures
• eBD should be avoided with deep ulceration or suspected malignancy, and repeat dilation is commonly required
• The evidence does not define a single universal threshold for when to bypass first outside favorable short, accessible strictures.

References

1. Youn JW, Hahn JW, Yang HR. Comparison of Duodenal Strictures Between Crohn's and Non-Crohn's Diseases in Children. Pediatr Gastroenterol Hepatol Nutr. 2025. PMID: 41001440.

2. Lusetti F, Bezzio C, De Bernardi A, Puricelli M, Manes G, Saibeni S. Upper Gastrointestinal Crohn's Disease: Shedding Light on the Obscure L4 Classification Meaning. J Clin Med. 2025. PMID: 41303293.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.