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Balloon dilatation safely, effectively treated Crohn’s disease strictures
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Endoscopic balloon dilatation in patients with strictures caused by Crohn’s disease safely and effectively resulted in long-term symptom improvement and allowed most patients to avoid surgery in a recent study.
In a multicenter retrospective audit across four UK teaching hospitals from 1998 to 2011, 79 patients (median age, 48 years; 59.4% women) with Crohn’s disease (CD) strictures met study inclusion. Forty-eight (60.7%) patients had ileocolonic anastomotic strictures; the remainder had de novo strictures.
In all 191 endoscopic balloon dilatations (EBD) were performed on 93 strictures during a median of 1 year (range, 1–84 months). EBD success was defined as symptomatic improvement without the need for surgery at follow-up.
EBD successfully improved CD patients’ stricture symptoms and allowed 77% of patients to avoid surgery. They included 34% of cases at index EBD. Researchers said 43% of patients, however, needed more than one EBD to achieve a long-term response without surgical intervention.
Of the 18 patients (23%) who required surgery, time to surgery after the first EDB was 2.6 to 71.1 months. Longer CD duration (P=.03) and high C-reactive protein level (P=.008) were associated with increased need for surgery.
Adverse events (4%) were considered “very low” for a 30-day period. No serious adverse events were reported.
“Our audit demonstrates that EBD of Crohn’s stricture provides an acceptable long-term avoidance of surgery and low complication rates,” the researchers wrote. “We recommend EBD should be considered as a treatment option in selected CD patients with a nonangulated, predominantly fibrotic stricture of the gastrointestinal tract, including the small intestine.
“A larger prospective, randomized trial of standardized EBD technique versus surgical intervention will now help to evaluate the key predictors of long-term EBD success.”
Disclosure: The researchers report no relevant financial disclosures.
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