Endoscopic intralesional platelet-rich plasma (PRP) injection after balloon dilation for colonic Crohn's disease strictures: a pilot study

Crohn's disease is a chronic condition where the body's immune system mistakenly attacks the digestive tract, causing inflammation that can lead to painful blockages. Over time, this inflammation can heal into thick, scar-like tissue that narrows the bowel, a problem known as a stricture. When these blockages occur, doctors often use a procedure called balloon dilation, where a deflated balloon is passed through an endoscope and inflated to stretch the narrowed area open. While this works well to clear the blockage temporarily, the scar tissue often grows back, forcing patients to undergo repeated procedures or face surgery. For years, researchers have searched for a way to keep the bowel open longer by treating the wound created during dilation, hoping to stop the scar from reforming. One promising avenue comes from the body's own healing system: platelet-rich plasma. This is a concentrated liquid made from a patient's own blood, rich in natural growth factors that help tissues repair themselves. While doctors have used this substance to speed up healing in broken bones or skin wounds, no one had ever tried injecting it directly into a narrowed section of the colon to see if it could prevent the scar from returning.

In a new pilot study conducted at the Sixth Affiliated Hospital of Sun Yat-sen University, a team of researchers tested whether this approach was safe and feasible for patients with Crohn's disease. They recruited twenty-nine adults who had developed narrowings in their colon. Before the procedure, the team drew a small amount of blood from each patient and spun it in a machine to separate the platelets, creating a custom healing solution. During the endoscopy, the doctors first stretched the narrowed section with a balloon. Immediately after, they injected one to two milliliters of the patient's own platelet-rich plasma into the stretched area at three or four different spots. The goal was to see if this extra boost of healing factors could calm the tissue and keep the passage open. The study was designed as a first step to check for safety and to gather initial data, rather than to prove the treatment works better than existing methods.

The results showed that the procedure was technically successful in every single patient. The doctors were able to perform the dilation and the injection without any major issues directly caused by the platelet-rich plasma. There were no cases of infection or unexpected bleeding linked to the injection itself. Two patients did experience delayed bleeding, but this was traced back to a separate minor procedure they had undergone to remove small growths called polyps, not the injection. One patient suffered a small tear in the bowel wall during the balloon stretching, which is a known risk of the dilation itself, but it was successfully sealed with a tiny metal clip. The study confirmed that injecting this healing fluid into the colon is safe and can be done without harming the patient.

When the researchers looked at how well the treatment kept the bowel open, the picture was more complex. They checked the patients three weeks after the procedure and found that nearly half of them had already developed a narrowing again, making it difficult for the endoscope to pass through. By the one-year mark, that number had risen, with more than three-quarters of the patients showing signs of restenosis. Ultrasound scans of the bowel wall did not show significant changes in thickness or width compared to before the treatment. The authors noted that because this study did not have a control group of patients who received only the balloon dilation without the injection, they cannot say for certain whether the platelet-rich plasma helped or not. The natural history of these strictures is difficult to predict, and the high rate of recurrence suggests that a single injection might not be enough to stop the aggressive scarring process in Crohn's disease.

Despite the lack of clear evidence that the treatment stopped the blockages from returning, the study provides a crucial foundation for future research. It proves that doctors can safely deliver this healing fluid directly into a narrowed colon using standard endoscopic tools. The researchers suggest that while a single dose may not be powerful enough to overcome the stubborn scarring of Crohn's disease, the safety of the method opens the door for testing different strategies. Future studies might explore giving the injection multiple times or combining it with other treatments to see if they can extend the time patients remain free of blockages. For now, this work stands as the first time this specific combination of balloon dilation and platelet-rich plasma has been tested in humans, offering a safe new tool for doctors to consider as they search for better ways to manage these difficult blockages.