Hydrostatic balloon dilatation of Crohn's strictures

Abstract

Aim: To evaluate the safety and long-term efficacy of per-endoscopic hydrostatic balloon dilatation in a retrospective series of patients with Crohn's disease. Methods: Thirty-eight patients had balloon dilatation for intestinal symptomatic strictures which were located as follows: ileo-colonic (26) or colocolic (2) anastomosis, colon (4), ileum (3), proximal jejunum (1) and ileocaecal valve (5); three patients had two strictures accessible to dilatation. The mean length of the strictures was 2.1 cm (s.d., 0.3 cm). Results: Thirty-two of the 38 patients were successfully dilated and followed for a median of 22.8 months (0.2-103 months) until surgery or last news. The probabilities of obstructive symptom recurrence were 36% at 1 year and 60% at 5 years. Twelve patients had a second dilatation, and three a third. The probabilities of surgery for stricture were 26% at 1 year and 43% at 5 years. Results were not influenced by age, sex, activity of the disease, passage of the stricture by the colonoscope or concomitant medical therapies. Complications occurred in 9.4% of the 53 dilatation sessions, with only one perforation. Conclusions: Hydrostatic balloon dilatation is effective for Crohn's symptomatic strictures, and can avoid or postpone surgery, with an acceptable rate of complications.

Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn’s disease: A prospective study

“…At the moment, it is difficult to define the relapse risk after endoscopic balloon dilatation, as the published studies [8,[17][18][19] are based on very different follow-up periods, and often do not represent structured prospective longterm studies.…”

“…Valid long-term studies of 5 years or more, which would permit a statement regarding recurrence of strictures and a better comparison with surgical techniques [3,4] , are available so far only in casuistic form and with limited numbers [8,[17][18][19] . We report on our own prospective 10-year long-term study of endoscopic balloon dilatation of strictures in Crohn's disease using a relatively thin balloon (18 mm) and additional treatment with prednisolone.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…[161][162][163][164][165][166] Two further case series did however report haemorrhage associated with dilation of ileal or colonic strictures in 1/20 (5%) 167 and 1/38 (2.6%) patients. 168 One study included dilation of malignant strictures and encountered no haemorrhagic complication in 94 cases (68 malignant and 26 anastomotic strictures). 169 In a RCT of pneumatic dilatation versus laparoscopic myotomy for achalasia there were no reported haemorrhages but 8/108 (9.5%) patients experienced perforation during the treatment course.…”

Dangers associated with endoscopic management of strictures in IBD

“…Even with these multiple dilatations the long-term success rates are imperfect. At 1 year Sabate et al 7 reported only a 64% symptom-free success rate, while at a mean of 29 months Thomas-Gibson et al 9 reported only 41% of patients free of symptoms. Morini et al 6 reported that at Ϸ64 months 52.9% of patients had avoided symptomatic recurrence, but this number excludes 9 of the original 43 patients in that study who were technical failures.…”

“…On an "intent to treat" basis, their success rate falls to 42%. Sabate et al 7 reported that 43% of their endoscopically dilated patients needed surgery at 5 years. Roughly speaking, these recurrence rates for endoscopic balloon dilatation are at least double that found after surgery done for stricturing CD.…”