Super-slim endoscopy, in a patient with a Crohn’s ileocecal valve stricture, for assessment of mucosal healing

Crohn’s disease (CD) is an inflammatory bowel (IBD) disease involving any segment of the gastrointestinal tract. Colonoscopy, in association with terminal ileum visualization and biopsies, is the gold standard for a correct endoscopic surveillance in CD patients [1]. Direct disease activity monitoring and histological grading represent the main advantage of endoscopy [2], helping physicians to optimize treatment. Ten to twenty-five percent of CD patients present with at least one small bowel or colonic stricture, which often prevents complete endoscopic examination. Thus, when standard endoscopes are unable to proceed beyond colonic or ileal strictures, more sophisticated and costly imaging techniques, such as entero-computed tomography (CT) or magnetic resonance imaging (MRI), are used. However, they do not allow histological evaluation or therapeutic procedures. The use of ultrathin endoscopy (UE) has been proposed in the case of narrow bowel angulations [3] and stricturing colonic lesions, in patients with ulcerative colitis [4] and CD [5, 6]. We describe the successful use of a super-slim, two-way angulation, endoscope (outer diameter 4.9 mm) to explore the terminal ileum in a patient with severe ileocecal valve strictures due to CD. The technique allowed us to successfully complete the examination of the terminal ileum, obtain biopsies, and optimize the treatment strategy.