Long‐Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn′s Disease: A Prospective Long‐Term Study

Abstract

Background The short-and long-term results of balloon dilation therapy in Crohn's patients with non-anastomotic obstructive gastrointestinal lesions are investigated.Materials and methods Fifty-five patients with Crohn's disease who had obstructive gastrointestinal lesions were treated prospectively by endoscopic balloon dilation.Short-term results Eight of the initial dilations were unsuccessful giving no symptomatic relief (14.5%).Long-term results The subjects of the long-term prognosis were 40 cases followed up for more than 6 months (average 37 months) and their strictures were non-anastomotic in more than half (59%). Avoidance of surgery, was possible in 31 of 40 patients (78%). Surgery was avoided in 92%, 81% and 77% of patients after one, two, and three years, respectively (Kaplan-Meier's method). There was no difference in long-term outcome between anastomotic strictures and strictures in the absence of prior surgery.Conclusion Our results suggest that, (1) strictures in the absence of prior surgery might be treated in this way as well as anastomotic strictures; (2) if followed for a prolonged time period, more than 70% of patients, who have undergone balloon dilation for obstructive gastrointestinal Crohn's disease, may be able to avoid surgery. of these underwent balloon dilation in our institute.All the procedures were performed by study members (T.M., S.T., K.Y. and S.S.) in a uniform procedure.Patients Thirty-two of the 55 patients were male. Age at the onset of gastrointestinal symptoms was ranged from 15 to 36 years (average 26.6). The diagnosis of Crohn's disease was confirmed endoscopically, radiographically or histologically. Before obstructive symptoms occurred, their disease had been followed for an average of 7.9 years (range 0.8-10.0). They were classified into 14 small intestinal (6 gastroduodenal), 34 ileocolitis, and 7 colitis type cases. At the time of dilation 32 (58%) had previously undergone surgery. Six patients had gastroduodenal stenoses and 49 patients had ileocolic stenoses. At the time of dilation 45 patients had mild to severe obstructive symptoms and 10 did not have obvious obstructive symptoms but had severe strictures which an endoscope was not able to pass through. These 10 patients had been recieving nutritional therapy (total parenteral nutrition or elemental diet) for active diseases for several weeks and were on nil by mouth. After disease activity had settled down to remission stage (CDAI < 150), colonoscopic evaluation revealed severe stenosis in these patients. They did not have obstructive symptoms because they had not ingest an ordinary diet yet. Seven of the ten asymptomatic patients turned out to be symptomatic during follow-up when on a regular diet. Indications for DilationIndications for balloon dilation were as follows:(1) patients who had strictures in gastroduodenal lesions or ileocolonic lesions, (2) the activity of the disease was quiescent (CDAI < 150, in 48) or not highly active (150 < CDAI < 250, in 7), (3) their general condition was not extremely p...

Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

“…In this study, patients without stenotic symptoms were included as subjects, and the maximum observation period after EBD was only 3 years. Therefore, the cumulative surgery-free rate was approximately 70% at 3 years, similar to the results of previous studies (17)(18)(19)(20)(21)(22)(23)(24)(25)32). The cumulative rate of surgery in CD reportedly ranges from 46% to 62% at 5 years and from 61% to 75% at 10 years.…”

“…EBD is an alternative to surgery in CD cases with intestinal stenosis. The use of EBD for the stenotic lesions of CD has been reported since the 1990s, with the procedure being conducted using an upper gastrointestinal endoscope or colonoscope mainly for the stenosis in the upper gastrointestinal tract, in the large intestine, or at the anastomotic site (17)(18)(19)(20)(21)(22)(23)(24)(25).…”

“…The incidence of perforation is reportedly 0-9%, and this complication accounts for 5-25% of all cases with serious complications (17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)33). In this study, portal emphysema developed in one patient (34); this complication was apparently attributable to the excessive CO 2 gas insufflation at the time of scope insertion, in addition to a pre-existing tendency for intestinal gas retention.…”

“…Advancements in endoscopic techniques and drug therapy, especially biological products, have enabled endoscopic dilation to be applied for intestinal stenosis in patients with CD, followed by enhanced medical treatments and the postponement or even avoidance of surgery (17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Efficacy and Safety of Endoscopic Balloon Dilation for Crohn's Strictures

“…[3][4][5][6][7][8] However, there are few data concerning the long-term results of this treatment for Crohn_s strictures. [9][10][11][12] We investigated the safety and long-term efficacy of endoscopic hydrostatic balloon dilation for intestinal strictures in Crohn_s disease in a retrospective series.…”