Multiple Crohn’s strictures lead to poor balloon dilation response

PHILADELPHIA — Patients with multiple Crohn’s disease-associated strictures experience less success with endoscopic balloon dilation, according to research presented at the American College of Gastroenterology Annual Meeting.

“Endoscopic balloon dilation has been proven in multiple publications to be effective in treating these patients,” Nan Lan, MD, of the Cleveland Clinic, said during her presentation. “However, it comes to primary stricture, a recent study from our institution showed that the patients who underwent balloon dilation have a much lower surgery-free survival compared to patients who underwent surgical resection.”

Researchers analyzed data from 117 patients with primary stricturing ileocolic CD initially treated with balloon dilation between 2000 and 2016 and separated them into two groups; patients with a single stricture (n = 81), and patients with multiple strictures (n = 36). The primary outcome was surgery-free survival, and the secondary outcome was post-procedural adverse events.

Lan said patients with multiple strictures required multiple dilations, had shorter intervals between treatment and had higher rates of nausea and vomiting. Additionally, investigators observed post-dilation perforation only in patients with multiple strictures.

The subsequent surgery rate was higher in patients with multiple strictures (66.7% vs. 35.8%; P < .002), while both decreased number of balloon dilation sessions (HR = 0.6; 95% CI, 0.5–0.7) and shorter interval of sessions were protective for surgery-free survival (HR = 0.2; 95% CI, 0.1–0.3).

Researchers found that patients with more than three strictures were at a significantly higher risk for subsequent surgery (HR = 14.1; 95% CI, 1.6–120.3), while patients with two to three were not (HR = 1.5; 95% CI, 0.8–2.8).

“Multiple strictures treated with balloon dilation are slightly shorter and traversable,” Lan said. “Therefore, these patients can achieve immediate technical success. However, most of them would require frequent re-dilations, and these patients had to suffer higher rates of perforation, as well as a higher rate for subsequent surgery.” – by Alex Young

Reference :

Lan N, et al. Abstract 51. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: The authors report no relevant financial disclosures.