Experience with Balloon Dilatation in Crohn’s and Non-Crohn’s Benign Small-Bowel Strictures: Is There a Difference?

Abstract

Background/Aim. Endoscopic balloon dilation (EBD) has been effective for small-bowel strictures in patients with Crohn’s disease (CD). However, its efficacy and indication for small-bowel strictures in non-CD patients have not been established. This study evaluated the clinical efficacy and safety of EBD for small-bowel strictures in non-CD patients compared with CD patients. Methods. Ninety-eight consecutive patients (mean age, 53 years; average observation period, 45 months) with small-bowel strictures diagnosed by double-balloon endoscopy were retrospectively evaluated at Hiroshima University Hospital from August 2003 to April 2017. The average number of procedures, short-term and long-term EBD success rates, and safety profiles between the non-CD and CD groups were examined. Results. Surgery was selected as the initial treatment in 44 cases (45%) (non-CD group, 27 (61%); CD group, 17 (39%)) as EBD is not indicated. Fourteen non-CD patients had strictures due to malignant tumors, while 13 patients had benign strictures. Twenty-three patients (non-CD, 12; CD, 11) underwent EBD. Forty-three EBD procedures were performed for 17 stricture sites (average: 2.5 procedures/site) in non-CD patients and 41 EBD procedures for 18 stricture sites (average: 2.3 procedures/site) in CD patients. The short-term success rate was 100% (23/23), whereas the long-term success rate was 92% (11/12) in non-CD patients and 82% (9/11) in CD patients. No significant differences in the surgery-free rate occurred between both groups. Furthermore, one adverse event, bleeding after EBD, was encountered in the non-CD group (8%, 1/12). Conclusion. EBD for small-bowel strictures demonstrated good clinical outcomes in non-CD patients.

Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment

“…Endoscopic dilatation is possible for both small bowel and colonic strictures and is shown to be effective in the majority of these cases, however, the strictures that were dilated were mostly short and single. [ 121 122 123 ] Likewise, tubercular strictures in the upper GIT respond poorly to ATT with a mere 19% response rate. Furthermore, endoscopic dilatation was feasible and in combination with ATT found to be efficacious.…”

Safety and efficacy of non-fluoroscopic endoscopic dilatation of gastrointestinal tuberculosis related strictures

“…Similarly, colonic tubercular strictures were dilated successfully in 22 (of total 130 GITB) patients and it helped increase the diagnostic yield by 23% post dilatation [14]. Unlike strictures associated with Crohn's disease, benign etiologies like tuberculosis may need less sessions of dilatation for complete resolution [15]. This is because the ATT takes care of the underlying disease process resulting in the abatement of ongoing inflammation.…”