Medical, endoscopic, and surgical management of ileal pouch strictures (with video).

The construction of ileal pouch–anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Furthermore, IPAA has the advantage of preserving the natural route of defecation, unlike the Brooke’s ileostomy or continent ileostomies. On the other hand, the natural history of patients with the ileal pouch can be complicated by various surgical procedure–associated mechanical adverse events as well as inflammatory and functional disorders. Pouch strictures are one of the most common adverse events after IPAA, with a reported frequency ranging from 10% to 17%. Pouch strictures may or may not be related to Crohn’s disease (CD). Pouch strictures can be primary and secondary, based on the etiology, and distal afferent limb, inlet, pouch body, and anastomotic strictures, based on the location. There are scant published data on the management of ileal pouch strictures. Medical therapy seems to be of limited value in the management of these strictures. Because of the mechanical nature of these strictures, endoscopic balloon dilation (EBD) and endoscopic stricturotomy are effective to reduce the need for surgery and the risk for pouch failure. Resection and anastomosis and stricturoplasty are 2 main surgical treatment modalities, which could be used to salvage