LAUSR

A 34-year old man had been diagnosed with Crohn’s disease over 3 years ago and had received biologic agents and enteral nutrition. Colonoscopy had shown stricture of the ileocecal orifice, and endoscopic balloon dilation had been performed on this 3 months ago. On his current presentation for reexamination, colonoscopy again showed stricture of the ileocecal orifice (▶Fig. 1) with multiple nodular hyperplastic polyps covering the area around the orifice (▶Fig. 2). Snare polypectomy was first done until the orifice appeared, then an IT2 knife was used to perform stricturotomy. The stricturotomy successfully dilated the stricture (▶Fig. 3), and as for the remaining polyps we decided to “trim” them with the electrical snare to improve the appearance of the ileocecal valve (▶Fig. 4); the procedure is called ileocecal valve-plasty (▶Video 1). We have performed ileocecal valve-plasty in 6 similar cases before (5 were ileocecal valve strictures and 1 was an anastomotic stricture, and in 1 case snare polypectomy was done before dilation). No adverse events occurred in these cases. Follow-up after the procedure showed recurrent stricture in 2 patients, while 1 patient had no recurrence in 65 months. One patient was lost to follow-up, and the rest had their procedures performed recently. It is important to select appropriate cases for this endoscopic plasty. The plasty can be performed in two ways: (i) polypectomy after dilation or stricturotomy to make the intestine look better and perhaps help reduce recurrence; (ii) polypectomy before dilation or stricturotomy to facilitate the latter procedure.