Digestive strictures are a major cause of morbidity in Crohn’s disease (CD), yet their endoscopic assessment and contribution to treatment allocation remain underreported.

Our aim was to characterize the endoscopic features of CD-related strictures and evaluate how endoscopy influences subsequent medical or surgical management.

We performed a 10-year retrospective study of adult CD patients with clinically and radiologically confirmed digestive strictures. Endoscopic parameters included location, traversability, ulceration, and histology. Post-endoscopic therapeutic decisions and outcomes after medical therapy were analysed.

Eighty-eight patients were included, with an average age of 39 years ± 12 and a sex ratio M/F = 1.3. The stricture was the initial presentation of CD in 36% of cases and was symptomatic in 88%. Endoscopy was performed in 90% and confirmed the diagnosis in 78%. The ileocecal valve was the most frequent location (38%), followed by anastomotic (20%), colonic (10%), ileal (6%), and duodenal (4%) locations. Upper gastrointestinal strictures (3%) were identified exclusively by gastroscopy.   Strictures were non-traversable in 92% and ulcerated in 68%. Biopsies were performed in all cases, with malignancy excluded in all. Among patients responding to medical therapy (39%), follow-up endoscopy demonstrated complete resolution of the stricture in all evaluated responders. In contrast, persistent stenosis was observed in 32% of non-responders (n=34), leading to surgical referral in more than half (n=18).

Endoscopy plays a decisive role in the diagnostic confirmation and morphological characterization of CD-related strictures. It directly influences therapeutic pathways by identifying inflammatory strictures responsive to medical therapy and persistent stenoses requiring surgery. These findings highlight the central role of endoscopic evaluation in the multidisciplinary management of stricturing CD.