What is your approach to terminal ileal structure in the setting of a new diagnosis of Crohn’s disease on index colonoscopy?

If there have been episodes of symptomatic obstruction or if there is proximal dilation on imaging, I would forgo any medical therapy and move straight to resection.

I would not dilate a stricture at presentation.

I would decide the length of ileal disease, if complicated (stricture or fistula), and if localized to the ileum.

If all of the above, I would resect, vis-à-vis the LIR!C trial.

Before operating on patients with strictures, especially with Crohn's disease, I would make sure medical treatment is optimized. And if a dilation is necessary, I would make sure the doctor who it is referred to is very capable and has a lot of experience, because these strictures can be very diffic...