Clinical Endoscopy

Case Report

Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy: Kyunghwan Oh, Kee Don Choi, Hyeong Ryul Kim, Tae Sun Shim, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park; Clin Endosc 2023;56(2):239-244. Published online December 21, 2021; DOI: https://doi.org/10.5946/ce.2021.215

Tuberculosis is an adverse event in patients with Crohn’s disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn’s disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient’s condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

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Focused Review Series: Current Statuses of Endoscopy in the Management of Inflammatory Bowel Disease

Endoscopic Balloon Dilation for Crohn’s Disease-Associated Strictures: Thomas Klag, Jan Wehkamp, Martin Goetz; Clin Endosc 2017;50(5):429-436. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.147

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Management of intestinal strictures associated with Crohn’s disease (CD) is clinically challenging despite advanced medical therapy directed toward mucosal healing to positively influence the natural course of CD-associated complications. Although medical therapy is available for inflammatory strictures, therapy of fibrostenotic strictures is the domain of surgery and endoscopy. Endoscopic balloon dilation (EBD) has been recognized as a well-established first-line procedure in terms of safety and efficacy. Although surgery is a valuable treatment modality for the management of CD-related strictures, EBD can help prevent multiple surgical interventions, which might in the long-term lead to a risk of short bowel syndrome. In this review we discuss requirements, techniques, safety, short- and long-term outcomes, as well as combinations of this procedure with surgical and medical treatment in CD-associated intestinal strictures.

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Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn’s Disease: Hsu-Heng Yen, Chen-Wang Chang, Jen-Wei Chou, Shu-Chen Wei; Clin Endosc 2017;50(5):417-423. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.142

Abstract PDF PubReader ePub

Inflammatory bowel diseases are idiopathic inflammatory diseases of two main types, Crohn’s disease and ulcerative colitis. Crohn’s disease can affect the entire gastrointestinal tract, and the distal ileum is involved in up to 70% of patients. Moreover, Crohn’s disease in one-quarter to one-third of patients involves isolation of the small bowel. Due to the nonspecific symptoms and anatomical location of the disease, small bowel Crohn’s disease is a phenotype that is particularly difficult to manage. Since the introduction of capsule endoscopy in 2000 and balloon-assisted enteroscopy in the 21st century, it is now possible to directly inspect for small bowel Crohn’s disease. However, the new modalities still have limitations, such as capsule retention and invasiveness of balloon-assisted enteroscopy. The diagnostic yields of both capsule endoscopy and balloon-assisted enteroscopy are high for patients with suspected small bowel Crohn’s disease. Therefore, earlier use of capsule endoscopy or balloon-assisted enteroscopy can help with the diagnosis and earlier treatment of these patients to avert possible disastrous outcomes.

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Case Report

A Case of Gastrointestinal Amyloidosis as a Complication of Crohn’s Disease: Kee Tae Park, M.D., Dae Hwan Kang, M.D., Cheol Woong Choi, M.D., Su Bum Park, M.D., Jae Hyung Lee, M.D., Bong Gap Kim, M.D., Suk Hun Kim, M.D. and Hyung Wook Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):401-405. Published online May 22, 2011

Abstract PDF: Amyloidosis is a disorder resulting from extracellular deposition of insoluble fibrils and causes dysfunction in many organs. Secondary amyloidosis, caused by chronic infectious and inflammatory disease, may involve the kidneys, liver, bone marrow and gastrointestinal tract. Involvement of the gastrointestinal tract is common and presents various symptoms according to location. Amyloidosis as a complication of Crohn’s disease is a rare but serious complication that may worsen the prognosis. We report a case of gastrointestinal amyloidosis in a 59-year-old male patient with Crohn’s disease that was diagnosed with an endoscopic forceps biopsy of the stomach, terminal ileum and colon.

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