Anorectal stricture is the most challenging complication of perianal Crohn disease, and it often has a severe negative impact on the patient's quality of life. Limited by the narrow anatomical space around the anorectum, how to address the stricture symptoms while preserving sphincter function and avoiding complex surgery is one of the clinical challenges for surgeons. There are few studies on anorectal stricture in Crohn disease, and how to provide patients with the best clinical evaluation and treatment options is an urgent issue. The article summarizes the endoscopic and surgical treatments for anorectal stricture in Crohn disease in the hope that it will provide a useful reference for clinical decision-making by specialists.

1.Bouguen G, Trouilloud I, Siproudhis L, et al. Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn's disease  in patients treated with infliximab[J]. Aliment Pharmacol Ther, 2009,30(7):749-756.DOI: 10.1111/j.1365-2036.2009.04089.x.

2.Yamamoto T, Allan RN, Keighley MR. Effect of fecal diversion alone on perianal Crohn's disease[J]. World J Surg, 2000,24(10):1258-1262, 1262-1263.DOI: 10.1007/s002680010250.

3.Linares L, Moreira LF, Andrews H, et al. Natural history and treatment of anorectal strictures complicating Crohn's  disease[J]. Br J Surg, 1988,75(7): 653-655. DOI: 10.1002/bjs.1800750711.

4.Brochard C, Siproudhis L, Wallenhorst T, et al. Anorectal stricture in 102 patients with Crohn's disease: natural history in the  era of biologics[J]. Aliment Pharmacol Ther, 2014, 40(7): 796-803. DOI: 10.1111/apt.12894.

5.Fields S, Rosainz L, Korelitz BI, et al. Rectal strictures in Crohn's disease and coexisting perirectal complications[J]. Inflamm Bowel Dis, 2008, 14(1): 29-31. DOI: 10.1002/ibd.20264.

6.Hughes LE. Surgical pathology and management of anorectal Crohn's disease[J]. J R Soc Med, 1978, 71(9): 644-651. DOI: 10.1177/014107687807100904.

7.Hughes LE. Clinical classification of perianal Crohn's disease[J]. Dis Colon Rectum, 1992 ,35(10): 928-932. DOI: 10.1007/BF02253493.

8.Sandborn WJ, Fazio VW, Feagan BG, et al. AGA technical review on perianal Crohn's disease[J]. Gastroenterology, 2003, 125(5): 1508-1530. DOI: 10.1016/j.gastro.2003.08.025.

9.Bouchard D, Abramowitz L, Bouguen G, et al. Anoperineal lesions in Crohn's disease: French recommendations for clinical practice[J]. Tech Coloproctol, 2017, 21(9): 683-691. DOI: 10.1007/s10151-017-1684-y.

10.Bemelman WA, Warusavitarne J, Sampietro GM, et al. ECCO-ESCP consensus on surgery for Crohn's disease[J]. J Crohns Colitis, 2018, 12(1): 1-16. DOI: 10.1093/ecco-jcc/jjx061.

11.Garros A, Siproudhis L, Tchoundjeu B, et al. Magnetic resonance imaging and clinical assessments for perianal Crohn's disease: gain and limits[J]. Dig Liver Dis, 2014, 46(12): 1072-1076. DOI: 10.1016/j.dld.2014.08.003.

12.Choi SH, Kim KW, Lee JY, et al. Diffusion-weighted magnetic resonance enterography for evaluating bowel  inflammation in crohn's disease: a systematic review and Meta-analysis[J]. Inflamm Bowel Dis, 2016, 22(3): 669-679. DOI: 10.1097/MIB.0000000000000607.

13.Kashkooli SB, Samanta S, Rouhani M, et al. Bougie dilators: simple, safe and cost-effective treatment for Crohn's-related  fibrotic anal strictures[J]. Can J Surg, 2015, 58(5): 347-348. DOI: 10.1503/cjs.001315.

14.Bettenworth D, Gustavsson A, Atreja A, et al. A pooled analysis of efficacy, safety, and long-term outcome of endoscopic balloon dilation therapy for patients with stricturing crohn's disease[J]. Inflamm Bowel Dis, 2017, 23(1): 133-142 .DOI: 10.1097/MIB.0000000000000988.

15.Tilmant M, Serrero M, Poullenot F, et al. Endoscopic balloon dilation of colorectal strictures complicating Crohn's  disease: a multicenter study[J]. Clin Res Hepatol Gastroenterol, 2021, 45(5): 101561.DOI: 10.1016/j.clinre.2020.10.006.

16.Singh VV, Draganov P, Valentine J. Efficacy and safety of endoscopic balloon dilation of symptomatic upper and lower  gastrointestinal Crohn's disease strictures[J]. J Clin Gastroenterol, 2005, 39(4): 284-290. DOI: 10.1097/01.mcg.0000155128.31208.44.

17.Lan N, Shen B. Endoscopic stricturotomy with needle knife in the treatment of strictures from  inflammatory bowel disease[J]. Inflamm Bowel Dis, 2017, 23(4): 502-513. DOI: 10.1097/MIB.0000000000001044.

18.Moroi R, Shiga H, Nochioka K, et al. Endoscopic radial incision and cutting for benign stenosis of the lower  gastrointestinal tract: an investigation of novel endoscopic treatment in  multicenter trial[J]. J Gastroenterol Hepatol, 2022, 37(8): 1554-1560. DOI: 10.1111/jgh.15882.

19.王震龙，周致圆，姚丹华，等. 内镜下切开术治疗原发性克罗恩病肛管直肠狭窄的初步探讨[J]. 中国内镜杂志, 2021, 27(02): 83-86. [Wang ZL, Zhou ZY, Yao DH, et al. Preliminary study of endoscopic stricturotomy in treatment of primary anorectal strictures of Crohn's disease[J]. China Journal of Endoscopy, 2021, 27(02): 83-86.] DOI: 10.12235/E20200262.

20.Lan N, Shen B. Endoscopic stricturotomy versus balloon dilation in the treatment of anastomotic  strictures in crohn's disease[J]. Inflamm Bowel Dis, 2018, 24(4): 897-907. DOI: 10.1093/ibd/izx085.

21.Shen B, Kochhar G, Navaneethan U, et al. Practical guidelines on endoscopic treatment for Crohn's disease strictures: a consensus statement from the global interventional inflammatory bowel disease group[J]. Lancet Gastroenterol Hepatol, 2020, 5(4): 393-405. DOI: 10.1016/S2468-1253(19)30366-8.

22.Lee SW, Niec R, Melnitchouk N, et al. Transanal anorectal stricturoplasty using the Heineke-Mikulicz principle: a novel  technique[J]. Colorectal Dis, 2016, 18(1): 101-105. DOI: 10.1111/codi.13080.

23.Berman IR. Sleeve advancement anorectoplasty for complicated anorectal/vaginal fistula[J]. Dis Colon Rectum, 1991, 34(11): 1032-1037. DOI: 10.1007/BF02049972.

24.Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn's disease[J]. Br J Surg, 1998, 85(12): 1695-1698. DOI: 10.1046/j.1365-2168.1998.00959.x.

25.Simmang CL, Lacey SW, Huber PJ. Rectal sleeve advancement: repair of rectovaginal fistula associated with  anorectal stricture in Crohn's disease[J]. Dis Colon Rectum, 1998, 41(6): 787-789. DOI: 10.1007/BF02236270.

26.Kuroki H, Sugita A, Koganei K, et al. Postoperative results and complications of fecal diversion for anorectal Crohn's  disease[J]. Surg Today, 2023, 53(3): 386-392. DOI: 10.1007/s00595-022-02556-x.

27.Singh S, Ding NS, Mathis KL, et al. Systematic review with Meta-analysis: faecal diversion for management of perianal  Crohn's disease[J]. Aliment Pharmacol Ther, 2015, 42(7): 783-792. DOI: 10.1111/apt.13356.

28.Leenen LP, Kuypers JH. Some factors influencing the outcome of stoma surgery[J]. Dis Colon Rectum, 1989, 32(6): 500-504. DOI: 10.1007/BF02554506.

29.Post S, Herfarth C, Schumacher H, et al. Experience with ileostomy and colostomy in Crohn's disease[J]. Br J Surg, 1995, 82(12): 1629-1633. DOI: 10.1002/bjs.1800821213.

30.Yamamoto T, Kotze PG, Spinelli A, et al. Fistula-associated anal carcinoma in Crohn's disease[J]. Expert Rev Gastroenterol Hepatol, 2018, 12(9): 917-925. DOI: 10.1080/17474124.2018.1500175.

31.Galandiuk S, Kimberling J, Al-Mishlab TG, et al. Perianal Crohn disease: predictors of need for permanent diversion[J]. Ann Surg, 2005, 241(5): 796-801, 801-802.DOI: 10.1097/01.sla.0000161030.25860.c1.

32.Fichera A, McCormack R, Rubin MA, et al. Long-term outcome of surgically treated Crohn's colitis: a prospective study[J]. Dis Colon Rectum, 2005, 48(5): 963-969. DOI: 10.1007/s10350-004-0906-3.

33.Lopez J, Konijeti GG, Nguyen DD, et al. Natural history of Crohn's disease following total colectomy and end ileostomy[J]. Inflamm Bowel Dis, 2014, 20(7): 1236-1241. DOI: 10.1097/MIB.0000000000000072.

34.de Buck VOA, Wolthuis AM, Vermeire S, et al. Intersphincteric proctectomy with end-colostomy for anorectal Crohn's disease  results in early and severe proximal colonic recurrence[J]. J Crohns Colitis, 2013, 7(6): e227-e231. DOI: 10.1016/j.crohns.2012.07.023.

35.Lightner AL, Steele SR, Delaney CP, et al. Colonic disease recurrence following proctectomy with end colostomy for anorectal  Crohn's disease[J]. Colorectal Dis, 2021, 23(9): 2425-2435. DOI: 10.1111/codi.15777.

36.潘唯潇,葛媛媛,丁康.克罗恩病直肠肛管狭窄的研究现状[J].结直肠肛门外科, 2023, 29(04): 412-416. [Pan WX, Ge YY, Ding K. Current status of rectal stenosis in Crohn's disease[J]. Journal of Colorectal & Anal Surgery, 2023, 29(04): 412-416.] DOI: 10.19668/j.cnki.issn1674-0491.2023.04.022.