Endotherapy for Ileo-colonic Tubercular Strictures

Background: Gastrointestinal tuberculosis can be classified as ulcerating, hypertrophic, and stricturing based on gross pathological findings. Surgery with right hemicolectomy and ileotransverse anastomosis is currently accepted as the standard of care for symptomatic ileo-colonic strictures. Endotherapy is now emerging as a less invasive option especially for short length stricture <3 cm. This case series of 3 patients aims to highlight the successful application of endotherapy encompassing stricturotomy and balloon dilatation in the management of tubercular stricture.

Methods: We present a case series of 3 female patients with age ranging from 20 to 44 years with symptomatic ileo-colonic tubercular strictures who were either receiving or had completed anti tubercular therapy were subjected to either endoscopic balloon dilatation (EBD), stricturotomy or a combination of both procedures. Stricturotomy was done using IT knife or with ERCP sphincterotome. Stricture was located in the ascending colon in two patients and at the IC valve in one. The response was assessed clinically as well as technically. The endpoint of clinical success was the resolution of obstructive symptoms (abdominal pain, acceptance of normal diet, and weight gain). Technical success was defined as immediate traversability of the scope without resistance after the performance of the procedure.

Results: Both technical success and clinical success was achieved in all three patients. Whereas one patient had clinical success after 1 session of stricturotomy, the other two needed two sessions of EBD and combination respectively for resolution of symptoms. There were no procedure-related complications in any patients.

Conclusion: Endotherapy proves to be a safe and effective minimally invasive therapy for tubercular strictures that avoids surgery in these patients. This case series also highlights the potential of stricturotomy in the treatment of tubercular stricture which has not been described for the management of tubercular strictures.

Publication History

Article published online:
22 April 2024