Hybrid endoscopic stricturotomy and balloon dilation of ascending colon stricture with cecal fecaliths in Crohn’s disease guided by preprocedural intestinal ultrasound
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".