Approach to Endoscopic Balloon Dilatation in Pediatric Stricturing Crohn Disease: A Position Paper of the Endoscopy Special Interest Group of ESPGHAN

Abstract

Crohn disease (CD) is often complicated by bowel strictures that can lead to obstructive symptoms, resistant inflammation, and penetrating complications. Endoscopic balloon dilatation of CD strictures has emerged as a safe and effective technique for relieving these strictures, which may obviate the need for surgical intervention in the short and medium term. This technique appears to be underutilized in pediatric CD. This position paper of the Endoscopy Special Interest Group of European Society for Pediatric Gastroenterology, Hepatology and Nutrition describes the potential applications, appropriate evaluation, practical technique, and management of complications of this important procedure. The aim being to better integrate this therapeutic strategy in pediatric CD management.

Imaging and endoscopic tools in pediatric inflammatory bowel disease: What’s new?

“…In the 1 st year post-dilatation, surgery-free rates over 80% have been reported, although up to one-third may need repeat dilatation[ 6 , 20 , 21 ]. The European Society of Pediatric Gastroenterology, Hepatology, and Nutrition recently published a position paper on the use of endoscopic balloon dilatation for pediatric stricturing CD and highlighted the importance of an experienced endoscopist performing the dilation on short strictures (up to 5 cm) in the duodenum, terminal ileum, or colon with no associated fistula, phlegmon, or abscess[ 22 ]. Fluoroscopy at the same time could be considered but is not necessary for all patients.…”

“…Fluoroscopy at the same time could be considered but is not necessary for all patients. Both primary and postsurgical anastomotic strictures as well as inflammatory vs fibrotic strictures have had similar success rates with endoscopic dilatation[ 22 ].…”