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

Abstract

Introduction Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce. Methods A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients. Results Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn’s disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1–5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons. Conclusion Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.

Evidence-based approach to diagnosis and management of abdominal tuberculosis

“…Stricturing disease is common in GITB and may occur in a quarter of patients with GITB. While three-fourths of the stricturing disease have a clinical response to ATT (unpublished meta-analysis), many patients continue to be symptomatic even after ATT and require additional therapy (endoscopic dilatation or surgery) [61,62]. Further, many patients may present directly with intestinal obstruction and may need emergency surgery.…”

“…Further, many patients may present directly with intestinal obstruction and may need emergency surgery. In patients with ongoing symptoms in spite of ATT, endoscopic dilatation could be done for endoscopically reachable strictures [62]. The endpoint of dilatation is not well defined, but symptom resolution is aimed for.…”

“…The endpoint of dilatation is not well defined, but symptom resolution is aimed for. Usually, endoscopic dilatation is safe and efficacious [62]. Indirect evidence from CD-related strictures suggests a dilatation of 15-18 mm and passability of a standard colonoscope as additional criteria, but these have not been validated in the setting of GITB [35].…”

Images in GI Infection: Pseudo-Appendix-like Appearance of Post-Tubercular Gastrointestinal Stricture

“…2 Therefore, continuing symptoms even after antitubercular therapy may suggest the presence of sequelae such as strictures. 3…”

“…2 Therefore, continuing symptoms even after antitubercular therapy may suggest the presence of sequelae such as strictures. 3 Informed Consent Informed consent was obtained from the patient.…”