BACKGROUND AND AIMS Fecal diversion in Crohn’s disease (CD) promotes diversion proctitis and anorectal stricture formation, yet the endoscopic features and treatment outcomes remain unknown. We compared anorectal strictures and treatment outcomes in diverted vs nondiverted patients with CD. METHODS This retrospective comparative cohort study included consecutive patients with CD undergoing endoscopic treatment for anorectal strictures at a tertiary inflammatory bowel disease center from January 2020 to August 2026. Patients were classified as diverted (N = 10) or nondiverted (N = 26) at index treatment. RESULTS All 10 (100%) diverted patients had concurrent diversion proctitis vs 7 (26.9%) nondiversion group (P < 0.001). Anorectal strictures in the diversion group were uniformly severe or pinhole (100% vs 46.2%, P = 0.002) and longer (median, 2.5; IQR, 2.0, 3.0 vs 1.5; IQR, 1.5, 2.0 cm, P = 0.005). Of 104 procedures (23 diverted; 81 nondiverted), technical success was 100 of 104 (96.2%), but lower in the diversion group (19/23 [82.6%] vs 81/81 [100.0%], P = 0.002). Surgical resection was required in 2 (20.0%) diverted patients vs 1 (3.8%) nondiverted patient (P = 0.181). Endoscopic reintervention-free and surgical resection-free survivals did not differ significantly between groups. Three procedure-related adverse events occurred: 1 abscess and 1 bacteremia in diverted patients, and 1 bleeding event in a nondiverted patient. CONCLUSION Anorectal strictures in diverted patients with CD were uniformly accompanied by diversion proctitis and were more severe than in nondiverted patients. Despite lower immediate technical success, endoscopic treatment remained a viable therapeutic option without significant differences in long-term outcomes. Procedure-associated infectious complications may occur in the diversion group.
Background/Aims Radiation exposure during fluoroscopic procedures poses risks to both patients and medical staff. Although various protocols exist to mitigate these risks, the optimal pulse rate settings for radiation reduction remain unclear. This study aimed to evaluate the effectiveness of super low-rate pulsed fluoroscopy in reducing radiation dose during endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stone removal. Methods We retrospectively analyzed consecutive patients with common bile duct stones who underwent ERCP. Patient selection was based on two distinct time eras: procedures performed with pulsed fluoroscopy at 7.5 pulses per second (pps, standard-rate group) and 1.0 pps (super low-rate group) at a single center. The primary outcome was air kerma at the patient entrance reference point (Ka,r;mGy), and treatment-related indicators were analyzed. Results A total of 173 cases were analyzed (91 in the standard-rate group and 82 cases in the super low-rate group). The median value of Ka,r per procedure was significantly lower in the super low-rate group than in the standard-rate group (2.13 mGy vs 7.80 mGy). No significant differences were observed between groups in fluoroscopy time, procedure time, procedure success rate or adverse events. Multivariable regression analysis revealed that the super low pulse rate was associated with an 11.9 mGy dose reduction. Conclusions Using super low-rate pulsed fluoroscopy at 1.0 pps during ERCP was associated with significantly lower radiation exposure, with no observed deterioration in short-term procedural outcomes.
Bariatric surgery is an effective treatment for obesity; however, it remains among the more invasive therapeutic options and is associated with both short- and long-term complications. Given the increased risks associated with repeat surgical interventions, minimally invasive approaches are generally preferred for the management of post-bariatric complications. Consequently, endoscopy has emerged as a valuable tool for the diagnosis and treatment of a broad spectrum of post-bariatric gastrointestinal complications, including ulceration, stenosis, gallstone disease, leaks, fistulas, and recurrent weight gain. This article reviews the current role of endoscopy in the management of complications following bariatric surgery.
