Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video)

Despott, Edward J.; Gupta, Arun; Burling, David; Tripoli, Eric; Konieczko, Krysia; Hart, Ailsa; Fraser, Chris

doi:10.1016/j.gie.2009.05.005

Cited by 113 publications

(93 citation statements)

References 29 publications

(28 reference statements)

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“…5 Balloon-enteroscopy is helpful to treat symptomatic small bowel strictures in Crohn's disease and in anastomotic strictures. 31,32 In Crohn's disease, inflammatory activity of the stenotic small bowel segment should endoscopically be excluded or accordingly treated with immunomodulators. Endoscopic dilation therapy is an option for short (< 3-4 cm), non-inflammatory strictures mainly due to scar tissues, and Figure 1.…”

Section: Endoscopic Resection Of Small Intestinal Polyps Stricture Dmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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Section: Endoscopic Resection Of Small Intestinal Polyps Stricture Dmentioning

confidence: 99%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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“…However, most investigations of EBD have been small-scale cohort studies, and the safety and long-term usefulness of EBD have not yet been adequately examined (27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

Kanamori

Sugaya²,

Tominaga³

et al. 2017

Turk J Gastroenterol

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Background/Aims: Endoscopic balloon dilation (EBD) can serve as an alternative to surgery for intestinal stenosis associated with Crohn's disease (CD). However, there has been controversy regarding the efficacy and safety of EBD. Here we sought to determine the therapeutic efficacy and safety of EBD for intestinal stenosis in CD. Materials and Methods: Of 43 patients with CD accompanied by intestinal stenosis, 30 underwent EBD. These 30 patients were examined retrospectively in terms of the scope passage rate, surgery-free rate, and whether or not the observation of the distal intestinal tract influenced the therapeutic strategy. Results: The overall scope passage and surgery-free rates were 90.0% and 76.7%, respectively. There were no statistically significant differences in the site of the dilated intestinal tract among groups. Patients who had inflammation in the distal intestinal tract alone after EBD accounted for 56.7%. The rate of re-dilation was 46.7%, and time until re-dilation was 6.6±3.6 months. Conclusion: EBD was associated with favorable short-term and long-term outcomes and good safety. Observation of the distal intestinal tract influenced the decision-making process for therapeutic strategies. The results of this study suggest that EBD may allow the postponement or even avoidance of surgery, enabling not only intestinal dilation but also the evaluation of mucosal healing to be performed. Thus, EBD is considered to be an effective alternative treatment for intestinal stenotic lesions in patients with CD.

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“…Recently, DBE enabled us to treat diaphragm disease in the small bowel [Mehdizadeh and Lo, 2006]. Most stricturing disease is not numerically excessive and can be managed endoscopically [Despott et al 2009;Ohmiya et al 2009;Pasha and Leighton, 2009]. …”

Section: Discussionmentioning

confidence: 99%

“…First, there are limited patient numbers [Ohmiya et al 2009]. In addition, the degree of dilatation is only stated in two series and both were in patients with CD [Despott et al 2009;Karstensen et al 2012]. Finally, there is no data to recommend a safe and effective approach to dilating small bowel strictures.…”

Section: Introductionmentioning

confidence: 99%

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience

Gill¹,

Kaffes²

2013

Therap Adv Gastroenterol

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Background: There is little data on the role of balloon enteroscopy and small bowel strictures. We aim to characterize the diagnostic role of double balloon enteroscopy (DBE) in small bowel strictures and document the outcomes of dilatation. Methods: This is a retrospective review from a single tertiary referral centre DBE database from July 2004 to September 2012. All patients with suspected strictures in the small bowel undergoing DBE were included. The position of the small bowel strictures considered for dilatation was determined by diagnostic imaging, i.e. CT enterography, MR enterography or capsule endoscopy in the workup before DBE. Endpoints included stricture description, dilatation parameters and response to treatment. Main outcome measurements were the safety and efficacy of DBE and dilatation. Results: From our DBE database of 594 patients, a total of 32 patients underwent 44 DBE procedures for suspected or known strictures. Stricture aetiology included Crohn's disease (CD), nonsteroidal anti-inflammatory drugs (NSAIDs), surgical, Beçhets disease and one unknown. A total of 17 patients did not undergo dilatation as the strictures were ulcerated, nonobstructing or of uncertain aetiology. From the total of 25 dilatations in 15 patients that were attempted, 8/15 (53%) patients had 1 dilatation, 5 patients had 2 dilatations, 1 had 3 dilatations and 1 had 4 dilatations. The mean dilatation diameter was 14 mm. Three patients underwent surgery post-dilatation (2 for perforation). Mean follow up was 16 months. Conclusion: DBE is a useful method in determining the need for dilatation by assessing for active ulceration. Dilatation is effective in the 10-18 mm range, however perforation does occur.

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Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video)

Cited by 113 publications

References 29 publications

Interventional balloon-enteroscopy

Interventional balloon-enteroscopy

Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience

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