Fibrotic jejunal stricture: dilation or resection

What is known

• Strictures suitable for dilation are single, short (<4 – 5 cm), and without associated fistula or abscess; inflammation is not an absolute contraindication. ^1,2
• In short fibrous small-bowel or anastomotic stenoses without acute inflammation or perforating complications, balloon dilation, or strictureplasty if endoscopic access is impossible. Is advised, with resection reserved for other cases. ³
• EBD is safe and can defer or avoid surgery in selected patients, though recurrent obstructive symptoms frequently require repeat dilations. ^4–6
• Reported 5-year reoperation rates are comparable (~20-38%) across balloon dilation, strictureplasty, and resection. ³

What is unknown / caveats

• Retrieved data on EBD concentrate on duodenal/upper-GI and anastomotic strictures, not primary jejunal strictures specifically
• No randomized EBD-vs-resection trial in the excerpts; evidence is cohorts, case series, and a meta-analysis of non-randomized studies
• Jejunal location may be endoscopically inaccessible, which itself narrows the choice toward surgery
• Endoscopic accessibility of a jejunal stricture is often the deciding practical factor and is not addressed for the mid-jejunum in the retrieved evidence.

References

1. [No authors listed]. A multidisciplinary approach to diagnosis and management of bowel obstruction. Current problems in surgery. 2018. PMID: 30526888.

2. Legnani PE, Kornbluth A. Therapeutic options in the management of strictures in Crohn's disease. Gastrointest Endosc Clin N Am. 2002. PMID: 12486946.

3. Makowiec F, Starlinger M. [Gastroduodenal involvement and circumscribed intestinal stricture in Crohn disease]. Zentralbl Chir. 1998;123(4):338-43. PMID: 9622891.

4. Tonelli F, Alemanno G, Bellucci F, Focardi A, Sturiale A, Giudici F. Symptomatic duodenal Crohn's disease: is strictureplasty the right choice?. J Crohns Colitis. 2013;7(10):791-6. PMID: 23165121.

5. Williams AJ, Palmer KR. Endoscopic balloon dilatation as a therapeutic option in the management of intestinal strictures resulting from Crohn's disease. Br J Surg. 1991. PMID: 2032105.

6. [No authors listed]. Efficacy, Safety, and Long-term Outcome of Serial Endoscopic Balloon Dilation for Upper Gastrointestinal Crohn's Disease-associated Strictures-A Cohort Study. Journal of Crohn's & colitis. 2017. PMID: 28881875.

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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.