If it is fibrotic and does not respond to balloon or manual dilation, the next step is typically not more dilation attempts, but surgery (unfortunately).

This would mean stricturoplasty or pouch advancement. Neither one is a cake walk.
http://www.medscape.com/viewarticle/433917

Have they tried injections into the stricture during balloon dilation? Sometimes they use steroids or antibiotics.

Jan

Thanks Jan.
No they haven't tried injections, but it's a good idea, I'll mention it to my doctors (have seen it also in some of Bo Shen's articles).
I prefer to keep using a Medina catheter (which is my default solution at this point) than going through more surgery !
Cheers, A