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Review: Endoscopic balloon dilation for Crohn's has short-term benefit
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A recent systematic review and meta-analysis of endoscopic balloon dilation for Crohn’s disease strictures showed most patients had symptomatic response in the short-term, but the majority of patients with 5-year follow-up data required surgery.
Aiming to determine the pooled incidence of clinical and technical response, adverse events and the effect of stricture characteristics on outcomes, researchers from the UK reviewed 10 prospective studies, 14 retrospective studies and one randomized controlled trial published from 1991 to October 2014 that reported outcomes of endoscopic balloon dilation for Crohn’s disease intestinal strictures in adults.
“Symptomatic response was defined as patients with an obstructive symptom-free outcome at the end of follow-up, technical response by the passage of the scope following [endoscopic balloon dilation] and adverse events by the proportion of patients who develop complications,” the researchers wrote.
The pooled data reported on 1,089 patients, 790 strictures and 2,664 dilations (51% women; median age at first dilation, 41.1 years [range, 32.5-50 years]; median maximum follow-up, 83.5 months [range, 12-172 months]; median minimum follow-up, 4 months [range, 0-84 months]).
Overall symptomatic response rate was 70.2% (95% CI, 60%-78.8%), technical response rate was 90.6% (95% CI, 87.8%-92.8%), complication rate was 6.4% (95% CI, 5%-8.2%) and perforation rate was 3% (95% CI, 2.2%-4%). Among patients with 5-year follow-up data, 75% required surgery. Subgroup meta-analyses showed no differences in outcomes based on stricture activity or type.
“The place for [endoscopic balloon dilation] in the management of Crohn’s strictures may need to be redefined,” the researchers concluded. “While a symptomatic response rate of 70.2% indicates short-term benefit, the longer term avoidance of surgery is not so positive.” – by Adam Leitenberger
Disclosures: Morar reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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