Endoscopic valvectomy of ileocecal valve stricture resulting in resolution of ileitis in Crohn’s disease

A 46-year-old woman presented to our Interventional Inflammatory Bowel Disease (i-IBD) unit with fibrostenotic small-bowel Crohn’s disease (CD) diagnosed 21 years earlier. She had frequent postprandial abdominal pain resulting from a stricture at the ileocecal valve (ICV). CT enterography delineated segments of terminal ileitis and colitis and inflammation and the stricture at the ICV. Colonoscopy revealed a deformed and strictured ICV, which was not traversable with a pediatric colonoscope. The ICV stricture was initially treated with endoscopic balloon dilation with a controlled radial expansion wire-guided balloon to 20 mm (A). A repeated colonoscopy 3 months later showed a normal colon and rectum, but persistent deformed and strictured ICV, which was again balloon-dilated to 20 mm Hg. However, the treated strictured ICV was still not traversable with the pediatric colonoscope. Subsequently, endoscopic needle-knife valvectomy was performed (B, C), and the stricture was traversed without resistance. There were multiple ulcers at the distal 15 cm of the terminal ileum. Colonoscopy 1 year afterward showed a widely patent previously treated ICV (D) along with resolution of ileitis; the patient had discontinued taking CD medications.