Discussion
Stenosis, primary stenosis, obstructive symptoms, stenosis
STENOSIS, RECURRENCE, INFLAMMATORY BOWEL DISEASE, SECONDARY, STENOSIS, COMPLICATIONS
Stenosis is one of the most frequent complications in patients with CD. When an ileum resection is required, more than 50% of patients will need a repeated surgical operation after 15 years, and more than 40% will have a recurrence of obstructive symptoms after 4 years [Another relevant issue is the management of a stenosis that is not localized in a previous site of surgery—de novo, or primary stenosis. The ECCO guidelines consider that EBD and surgery are both suitable treatment options for terminal ileum short stenosis (< 5 cm), although there are no studies comparing the two forms of treatment [In conclusion, there is currently no scientific evidence that allows us to determine the most appropriate treatment for de novo or primary stenosis (endoscopic vs surgical treatment). For this reason, we decided to carry out a clinical trial (EndoCir study) focused on the treatment of primary stenosis in CD: endoscopic treatment (first perform an EBD and if that fails then place a SEMS) vs surgical treatment. The main objective of the study will be to evaluate patients’ quality of life.The EndoCir trial is supported by the GETECCU and FSEED (Foundation of Spanish Society of Digestive Endoscopy) and includes fifteen tertiary and secondary centres, as well as experts in the management of inflammatory bowel disease. The researchers of the Hospital Universitari Mutua Terrassa have assumed the leadership and a primary role in centralizing the decisions in case of doubts and controversies, and in limiting heterogeneity.