Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Abstract

Intestinal strictures are common complications of Crohn's disease (CD). Endoscopic balloon dilatation (EBD) constitutes an alternative therapy to surgery, but associated factors of procedure success are inconclusive. Therefore, we aimed to evaluate the EBD success rate and its associated factors in CD patients.This is a retrospective cohort study of consecutive EBDs that were conducted between 2006 and 2014 among patients with CD with lower gastrointestinal tract strictures. Patients’ and stricture characteristics, short term procedure success and related complications at 1 week follow-up, and long-term clinical endpoints were documented.A total of 138 dilatations were performed on 64 CD patients. The overall dilatation success rate was 84.8%, with no difference between primary or anastomotic strictures, or between first or recurrent dilatation procedures. Long strictures (≥4 cm) were negatively associated with successful EBDs, but not with perforations. A multivariate analysis adjusting for age, sex, smoking, and disease duration revealed that a maximal dilatation diameter of ≥15 mm was positively associated with a successful EBD, while an inflamed stricture was negatively associated with procedure success. Strictures which were both long and inflamed were associated with the lowest EBD success rates compared with other strictures. Only 32.8% of patients required surgery during the follow-up period. Long-term prevention of surgery was negatively associated with stricture length and with a successful EBD.EBD is highly successful in treating intestinal strictures and in prevention of surgery in CD patients. Although EBD of long strictures is safe, it will not prevent surgery in the majority of cases.

Efficacy of drug and endoscopic treatment of Crohn's disease strictures: A systematic review

“…found in 55 patients with anastomotic strictures that increased stricture‐associated endoscopic inflammation (Rutgeerts score > i3) was associated with surgery (HR 4.55, 95% CI 1.08–19.29). Winder et al 47 . also found an inflamed stricture was associated with a decreased likelihood of treatment success (OR 0.19; 95% CI 0.06–0.57).…”

“…Other medications explored in combination with EBD included antibiotics that were found to be linked with an increased likelihood of reintervention in one study 69 and concomitant corticosteroids that were associated with repeated intervention in two studies 47,58 …”

“…Multiple predictors of treatment success were identified from the 60 endoscopic therapy studies. The most consistent predictor of treatment success was stricture length 22,47,48,52,58 . However, few studies included patients with strictures longer than 5 cm.…”

Endoscopic ultrasound-guided colo-colostomy in a case of acute large bowel obstruction

“…It is commonly a result of a malignant etiology; however, benign conditions such as strictures, volvulus, and radiation injuries may contribute to this condition 3 . Anastomotic strictures occur in up to 22 % of patients following colorectal resection and up to 70 % of them will eventually require surgical intervention 4 5 . Traditionally the approach taken in such cases has included endoscopic balloon dilation (EBD), self-expandable metal stent insertion or surgical intervention, with EBD being the primary modality because of its efficacy and safety profile 4 5 6 .…”

“…Anastomotic strictures occur in up to 22 % of patients following colorectal resection and up to 70 % of them will eventually require surgical intervention 4 5 . Traditionally the approach taken in such cases has included endoscopic balloon dilation (EBD), self-expandable metal stent insertion or surgical intervention, with EBD being the primary modality because of its efficacy and safety profile 4 5 6 . However, these approaches may not be feasible in all settings; therefore, in some cases, a different alternative may need to be considered.…”