Endoscopic Treatment for Crohn's Disease-related Deep Small Intestinal Strictures: Balloon-Assisted Enteroscopy-Guided Stricturotomy versus Balloon Dilation Therapy - A Single-Center Retrospective Study

Abstract Background Research data on balloon-assisted enteroscopy-guided stricturotomy (BAE-ES) versus endoscopic balloon dilation (BAE-EBD) for the treatment of Crohn's disease (CD)-related deep small intestinal strictures is limited. This study aimed to compare the efficacy and safety of BAE-ES versus BAE-EBD in treating CD-related deep small intestinal strictures. Methods This retrospective study included patients with CD-related deep small intestinal strictures who underwent either BAE-ES or BAE-EBD treatment between May 2021 and June 2025. Outcome measures included technical success, adverse events, and follow-up outcomes. Results A total of 100 CD patients underwent treatment (BAE-ES: n = 59; BAE-EBD: n = 41). BAE-ES: 73 BAE-ES procedures were performed on 59 patients. The technical success rate was 98.63% (72/73). Immediate bleeding occurred at 15 stricture sites (20.55%) in 15 patients (25.42%). BAE-EBD: 44 BAE-EBD procedures were performed on 41 patients. The technical success rate was 88.64% (39/44). Immediate bleeding occurred at 21 stricture sites (47.73%) in 21 patients (51.22%). Follow-up: BAE-ES: No cases of bleeding or perforation occurred during follow-up. 1 patient (1.69%) underwent partial small intestinal resection. Stricture recurrence requiring endoscopic re-intervention occurred at 2 sites (2.74%) in 1 patient. BAE-EBD: Bleeding occurred in 2 patients during follow-up; no perforations occurred. Four patients (9.76%) underwent partial small intestinal resection. Stricture recurrence requiring endoscopic re-intervention occurred at 6 sites (13.64%) in 6 patients; the treatment strategy was changed to BAE-ES, which achieved technical success. Conclusion BAE-ES demonstrates a higher technical success rate and favorable efficacy and safety profile for treating CD-related deep small intestinal strictures, warranting broader clinical application.