Outcome and complications of endoscopic balloon dilatations in various types of ileocaecal and colonic stenosis in patients with Crohn’s disease

Hagel, Alexander; Hahn, Anna; Dauth, Wolfgang; Matzel, Klaus E.; Konturek, Peter Christopher; Neurath, Markus F.; Raithel, Martin

doi:10.1007/s00464-014-3559-x

Cited by 24 publications

(30 citation statements)

References 28 publications

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“…Finally, for the authors, endoscopic dilatation is an effective and safe treatment for short strictures in CD. These results are in accordance with a recent Germanic study, including 77 patients undergoing endoscopic balloon dilatation, in which the success rate was about 65% [28] . Stenosis was postoperative in 57% of patients.…”

Section: Endoscopic Treatment: Dilatationsupporting

confidence: 81%

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Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others

Mège

2017

Dig Dis

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Background: In patients with ileo-colonic Crohn's disease (CD), the main consequence of the development of intestinal fibrosis is the occurrence of a localized symptomatic stenosis for which treatment is mandatory. Besides medical treatment, which is still considered to be ineffective against non-inflammatory fibrotic intestinal stenosis due to CD, there are 2 options for the treatment of such stenosis: endoscopic and surgical approaches. Key Messages: Endoscopic treatment includes balloon dilatation and stenting, and can be performed only on selected patients with very short stenosis. Few reports with a small sample size are available; long-term results of endoscopic treatment remain unknown, with patients being exposed to possible early recurrence of the stenosis. For this reason, intestinal resection currently remains the first option for localized symptomatic intestinal stenosis due to CD refractory to medical therapy. Laparoscopic ileocecal resection with ileocolonic anastomosis gives good short-term results, without mortality and with very low rate of morbidity. Furthermore, when the resection is shorter than 50 cm, very few functional consequences or no consequences are reported, and quality of life is improved. However, CD recurrence is frequent and can be required to redo surgery in up to 30% of the cases. In order to reduce the theoretical risk of short bowel syndrome, some surgeons have proposed strictureplasty as a more conservative approach. The concept is to treat stenosis without intestinal resection by opening the stenosis. There are different kinds of stricturoplasty, with similar reported morbidity and long-term recurrence rates than those observed with resection. Conclusions: Because no randomized study exists, it is difficult to know what the best option for symptomatic ileal stenosis in CD is. However, for a majority of patients today, ileocecal resection is the first option, strictureplasty being reserved by most of the surgeons for recurrent cases and/or multiple stenoses. It requires more experience to perform endoscopic treatment with long-term results.

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Section: Endoscopic Treatment: Dilatationsupporting

confidence: 81%

“…The management of perforation was a temporary stoma alone in one case and the resection of the perforated area with ileocolostomy in 3 cases. No predictive factors were estimated in this series [28] .…”

Section: Endoscopic Treatment: Dilatationmentioning

confidence: 99%

Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others

Mège

2017

Dig Dis

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“…Up to 34 % of the patients may expect a great benefit only after one procedure and further 24 % with repeated sessions [8]. Patients who got a first ED are at high risk of CD recurrence [91], since symptom recurrence after ED is common and has been reported in 13-100 % of patients [97]. Therefore, patients have to be followed up regularly to evaluate the symptomatic relief (general well-being, presence of abdominal pain or clear obstructive symptoms).…”

Section: Endoscopic Dilationmentioning

confidence: 99%

“…The initial diameter of the balloon is chosen by the endoscopist after careful analysis of prior CT or MR examinations and visualization of the stricture. Currently, no uniform approach in terms of dilation techniques has been defined regarding balloon size, duration, pressure of balloon insufflation, number of dilation procedures per patient or ileocolonoscopy, progressive/not progressive dilation, length/type/localization of strictures appropriate for dilation, and possibility to pass the endoscope after dilation [8,91]. In case of tight strictures or narrowed lumen, radiological re-canalization using a flexible hydrophilic guide wire can be attempted first and then a stiffer catheter passed through the stricture, which enables insertion of an appropriate guide wire for balloon dilation.…”

Section: Endoscopic Dilationmentioning

confidence: 99%

“…Endoscopic dilations are performed under unconscious sedation or general anesthesia, under constant monitoring of the vital parameters, and under concomitant fluoroscopic control [6]. In order to exclude an underlying malignant process (especially in the transverse colon and the rectosigmoid), 4-6 forceps biopsies can be made for further histopathological analysis [6,91]. Endoscopic dilation is carried out with a guide wire placed through the stenosis over which a high-pressure through-the-scope (TTS) balloon is placed.…”

Section: Endoscopic Dilationmentioning

confidence: 99%

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Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

et al. 2014

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Crohn's disease (CD) is a chronic inflammatory bowel disease that can involve virtually any part of the gastrointestinal tract. CD complications are the main indications for surgery. A large proportion of these interventions are due to stricturing disease. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD. Unfortunately, surgery is not curative, as the disease ultimately reoccurs in a substantial subset of patients. To best identify the patients who will require a specific treatment and to plane the most appropriate therapeutic approach, it is important to precisely define the type, the size, and the location of CD stenosis. Diagnostic approaches aim to distinguish fibrotic from inflammatory strictures. Medical therapy is required for inflammatory stenosis. Mechanical treatments are required when fibrotic CD strictures are symptomatic. The choice between endoscopic balloon dilation, stricturoplasty, and laparoscopic or open surgery is based on the presence of perforating complications, the remaining length of small bowel, and the number and length of strictures. The non-hierarchical decision-making process for the treatment of fibrotic CD therefore requires multidisciplinary clinical rounds with radiologists, gastroenterologists, interventional endoscopists, and surgeons.

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Endoscopy and Inflammatory Bowel Disease

Sharma

Venkatesh²,

Thomson³

2023

Pediatric Inflammatory Bowel Disease

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Outcome and complications of endoscopic balloon dilatations in various types of ileocaecal and colonic stenosis in patients with Crohn’s disease

Cited by 24 publications

References 28 publications

Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others

Unmet Therapeutic Needs: Focus on Intestinal Fibrosis Surgical Approach: Resection, Strictureplasty and Others

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

Endoscopy and Inflammatory Bowel Disease

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