Esophageal Crohn's Disease Management Algorithm
Assess for Active Symptoms and for Stricturing/Fistulizing Disease
Stricturing DX:
• Bx r/o Malignancy
• If Non-Traversable -> Esophagram & Imaging
• Tx Inflammatory Comp.
• Serial Dilation/ Self-dilation
• Injection Steroids? , IFX, Mitomycin C
• Refractory Fibrostenotic
- Stricturotomy
- SEMS
• PEG w/ EN; r/o Gastroduodenal Crohn's
• Esophagectomy
Fistulizing DX:
• Chest Imaging
• If Broncho/Pleural or Mediastinal Fistula: Consult CTS, Pulm., Adv. Endo
• Anti-TNF +/- IMM
• Consider PEG & EEN
• EGD w/ Fibrin Injection
• EGD +/- Bronchoscopy w/ SEMS
• Esophagectomy
Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD
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