The disease behavior of Crohn’s disease includes non-stenotic non-penetrating disease (simple mucosal involvement), stenotic (narrowing of the intestinal lumen and signs of obstruction), and penetrating (which may be associated with abscesses, fistulas, or inflammatory masses) disease. It is generally believed that stenotic lesions evolve from long-term chronic inflammation. stenosis associated with CD can lead to intestinal obstruction as well as fistulae, which were previously managed mostly by medical or surgical procedures. In recent years, endoscopy has gained increasing attention as a new treatment modality in the management of CD strictures. Diagnosis of strictures Imaging is an important tool in the diagnosis of inflammatory bowel disease (IBD) strictures, including CT enterography (CTE), magnetic resonance enterography (MRE), total gastrointestinal tract imaging, and enucleography.CTE is particularly important for the diagnosis of small bowel lesions, with the disadvantage of requiring intravenous iodine-containing contrast. Active CD shows fatty streak signs, mucosal enhancement, rectal vessel thickening, and intestinal edema on CTE, whereas fibrous stenotic lesions were previously thought to show narrowing of the intestinal lumen without active inflammation. However, a recent retrospective study of a small sample pointed out that the absence of mucosal inflammation on imaging does not necessarily indicate fibrous stenosis, and that active inflammation is also present in the intestine with fibrous stenosis. MRE is of particular value in discriminating fibrous stenotic lesions from inflammatory lesions, with low signal in T1 and T2 sequences characteristic of chronic fibrous stenosis and high signal in T2 imaging suggestive of inflammatory edematous stenosis. Fibrous stenotic lesions show fatty creep without tethered vascular signs and abscesses on MRE, and may have mild mucosal or submucosal thickening and enhancement. Although MRE is free of ionizing radiation, it is expensive, time consuming, requires the patient to hold their breath, and the images may be biased. Total gastrointestinal angiography can evaluate functional strictures of the intestine and intestinal motility, but also involves ionizing radiation and is less diagnostic than the other tests. Enucleation angiography can assess the presence of strictures or fistulas in the distal intestine, and understand the number and length of strictures and the presence of other lesions, with a diagnostic sensitivity of up to 100% for anastomotic strictures up to 8 mm. Endoscopic balloon dilation treatment Most IBD-associated ileocolic stenoses or colonic strictures can be treated with transendoscopic balloon dilation (TTS) instead of or with deferred surgery. Indications include those within 4 cm, with symptoms of stricture, and without fistula, abscess or tumor. The choice of the appropriate balloon (largest balloon first or progressively larger starting with a smaller balloon), antegrade or retrograde dilation depends on the nature of the stenosis, the technical difficulty and the experience of the operator. It is generally accepted that for patients with IBD, a minimum of 18 mm diameter balloon is required to achieve therapeutic benefit. Data from studies have shown that 71% to 100% of patients with IBD can achieve short-term symptomatic improvement and 44% to 66% can achieve long-term relief with this method. Endoscopic stenotomy with a small needle is a new technique. This technique was initially used to perform a pre-incision of fistulas in patients with difficult biliary placement, commonly due to mechanical obstruction such as fibrosis, tumors in the jugular abdomen, and stone compression. Again, similar mechanical obstruction problems can be encountered in IBD strictures, and the small needle knife is a valuable option. This approach is generally used for stenoses where balloon dilation no longer works and for fibroplastic stenoses, stenoses >4 cm in length. experienced individuals can perform safe and effective maneuvers, especially for stenoses close to the anus, with more flexibility in manipulating the endoscopic end and timely remedy in case of accidents (bleeding or perforation). Endoscopic stenting Endoscopic stenting is also an effective means. The long-term clinical remission rate is high. Nevertheless, because of the susceptibility to complications, measures related to the management of complications should be in place when endoscopic stenting is performed in patients with inflammatory bowel disease. Fistulas may be a part of CD disease. Clinically, patients with fistulas present with perianal fluid flow and pain during defecation. Although several symptomatic staging types have been described, the most widely accepted is the classification of fistulas into simple and complex types by Sandborn et al in the American Gastroenterological Association (AGA) Technical Review. Simple fistulas often have an external opening, are located distal to the dentate line, are often asymptomatic, are not associated with the vagina, and are not associated with perianal strictures. Complex fistulas are often associated with discomfort, are located proximal to the dentate line, often have more than one external opening, may involve the vagina, and may be associated with perianal stenosis. Endoscopic injections Multiple drug injections are used to treat CD fistulas, producing local inflammation that leads to fibrous exudation and tissue adhesions. Fibrin glue promotes fistula healing by forming a fibrous embolus. Although the long-term success rate of fibrin glue is low, it is still recommended for complex anal fistulas, mainly because of the safety and efficacy of the treatment. In conclusion, in many cases, endoscopic treatment is an effective measure to manage complications of inflammatory bowel disease. Knowledge of the indications for endoscopic treatment of IBD and an understanding of the associated risks can provide patients with reasonable treatment options and potentially delay or even avoid surgery. The application of endoscopic therapy requires adequate assessment of disease characteristics as well as good communication with surgery to avoid and promptly manage complications.