What are strictures/narrowing?

I was told by my GI i had some narrowing. Before he performed my pouchoscopy he did a DRE of my prostate and he dilated my anastomoses with his finger. He told me the narrowing was clinically insignificant and not to worry about it.

Most J-pouchers don't experience strictures. They can be caused by a variety of things and occur in different locations. You can help reduce the likelihood by keeping your GI tract healthy - if you have an inflammatory process going on  (pouchitis, cuffitis, Crohn's, etc.) then make sure to treat it as well as you can manage, with appropriate medication and monitoring.

@Scott F posted:

Most J-pouchers don't experience strictures. They can be caused by a variety of things and occur in different locations. You can help reduce the likelihood by keeping your GI tract healthy - if you have an inflammatory process going on  (pouchitis, cuffitis, Crohn's, etc.) then make sure to treat it as well as you can manage, with appropriate medication and monitoring.

Thanks! Seems inflammation is the root cause to most issue with a jpouch. I will try to keep it at bay then. Thanks!

@Scott F posted:

Most J-pouchers don't experience strictures. They can be caused by a variety of things and occur in different locations. You can help reduce the likelihood by keeping your GI tract healthy - if you have an inflammatory process going on  (pouchitis, cuffitis, Crohn's, etc.) then make sure to treat it as well as you can manage, with appropriate medication and monitoring.

I see people talking about self dialating, is this something everyone should do? I have never heard about it from any doctor I have met.

I should have put in my post that I have chronic cuffitis. I had associated inflammation as indicated by my elevated cal protectin scores. I take canasa daily, so I will know in January at my next scope if the slight narrowing returned.

As I stated prior, my GI said not to concern myself at  this point.  

The only place I have heard about self dilation is here, so I don’t know what my GI thinks about it, I will say though since I do not let anyone up there except the surgeon or GI, I don’t think it’s something I would want to perform on myself.

I had a stricture dilated at the J Pouch inlet in late 2020/early 2021. It was a balloon dilation done over 3 procedures which stretched it from about 7 mm to 18 mm if I recall correctly. I started a thread on it. If you search "balloon dilation" and find that thread, you will get the correct measurements. The dilation was not done by my GI- who admitted he had only done around 5 of them. He sent me to an advanced endoscopist at Yale, who was fantastic.

The original post in this thread asked a question that  implied one can do things to avoid a stricture. Many people get strictured at the J Pouch outlets or inlets due to ongoing inflammatory processes they are doing their best to control, but are unable to. Most J Pouch patients never get them, but those who deal with long term or chronic inflammatory processes may.

My J Pouch inlet stricture, just like many others, happened after over 25 years of treating inflammation at the inlet very aggressively. It's exacerbated by backsplash stool which exactly NONE of us can do a damn thing about. All that you can control is what you can control: which is not allowing inflammation to go untreated. And even if you do that, it could still happen.  If it happens, and your doctor cannot push a scope through inlet or outlet, balloon dilation would be a better idea than self dilation. But it's a risky procedure. The risks include perforation, sepsis and death.

One other thing: my GI and Endoscopist had a disagreement over the width to which the inlet should be dilated. My GI wanted 15 mm and the Endoscopist wanted 18. The Endoscopist won that debate. He was doing the dilation. I personally overheard the debate in my GI's office when he phoned the Endoscopist. They are friends BTW and the GI referred me to him so it was a friendly but professional debate.

I am getting scoped July 10, so we will see if the inlet is still good very soon. My last scope was in summer of 2022, 6 months after last dilation procedure in early 2021, and I was good at that time. I am now 1.5 years since my final dilation which was in January 2021 I believe, so we will see if it's still dilated.

I found the thread on my dilation experience, it's here:

https://www.j-pouch.org/topic/...pic-balloon-dilation

Self dilation is only reasonable for strictures at the pouch outlet, close to the anal opening. It’s used mainly with stubborn strictures that tend to recur without frequent attention - sometimes just to maintain the opening, and sometimes to gradually increase the opening.

I am going to post my pouchoscopy report from yesterday here because it is relevant to the issue of strictures and dilation. Before the procedure yesterday, my GI came to see me and told me he wanted to dilate me if I was too narrow at the J Pouch inlet. After some discussion about this, I gave him signed informed consent to do so. He reported to me the risk of perforation is 5%. In any event, he did not need to dilate me and his report indicates the J Pouch only has 1 ulcer and looks great. All the issues are at the afferent loop as these photos show. It's 30 plus years of not having a backsplash valve in the J Pouch.

here is the report- see first two pics:

Here is a diagram of the J Pouch enabling visualization of Afferent Loop:

Regarding inlet strictures, the explanation I received is that this can be simply a mechanical issue for some. There are two surgical approaches to connecting the pouch to the small bowel - an "end to end" anastomosis which results in a straight channel and a "side by side" anastomosis which takes a bit of a turn.   Either can result in their own type of stricture which may require endoscopic attention. I have a side-by-side, have been balloon dilated once - no inflammation involved in my case.  

AMB,

I only just saw your post now. That's interesting and I will ask myGI which type of anastomosis my surgeon did, as my surgeon passed away in 1996.

As a matter of interest my pathology report on my recent pouchoscopy just came back and here is a redacted version of it. These issues being described and the polyp are all at the inlet area that was strictured: