Hybrid endoscopic stricturotomy and balloon dilation of ascending colon stricture with cecal fecaliths in Crohn's disease guided by preprocedural intestinal ultrasound.

Background and Aims: Endotherapy for Crohn's disease (CD) strictures has evolved as a minimally invasive alternative to surgery. Hybrid techniques combining endoscopic stricturotomy (ES) and balloon dilation (EBD) can improve outcomes. Intestinal ultrasound (IUS) has emerged as a point-of-care tool for stricture assessment. We present a case using preprocedural IUS-guided hybrid ES and EBD to manage an ascending colon stricture with proximal fecaliths in CD. Methods: A 47-year-old man with ileocolonic CD (Montreal classification A2, L3, B2) receiving adalimumab and azathioprine presented with recurrent obstructive symptoms. IUS identified a short, predominantly fibrotic, ascending colon stricture. Earlier computed tomography enterography 6 months back ruled out additional strictures. On colonoscopy, ES was performed using an insulated-tip knife, followed by EBD up to 12 mm. Redundant mucosa was excised, and minor bleeding controlled. The stricture was successfully traversed, and fecaliths were extracted. Results: The procedure was uneventful, and the patient was discharged the next day after adalimumab escalation. At 9-month follow-up, he remained symptom-free. Conclusions: Hybrid ES and EBD guided by preprocedural IUS offer an effective multimodal approach for CD strictures, potentially delaying or avoiding surgery. Further studies are warranted to validate the long-term role of IUS in stricture management.