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Balloon Dilation Provides Alternative for Upper GI Crohn’s Strictures
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Endoscopic balloon dilation appeared to be a viable alternative to surgery for patients with Crohn’s disease who experience stricturing in the upper gastrointestinal tract, according to a meta-analysis published in Clinical Gastroenterology and Hepatology.
Dominik Bettenworth, MD, of University Hospital of Munster, in Germany, and colleagues wrote that while balloon dilation is a common treatment for stricturing in CD, data on procedures involving the upper GI tract are limited.
“[Endoscopic balloon dilation (EBD)] is frequently used for the treatment of CD-associated strictures throughout the gastrointestinal tract,” they wrote. “Most studies, however, do not provide a separate analysis on the use of EBD for CD-associated strictures of the upper GI tract. More specifically, the two largest available studies on this indication only include 24 and 35 patients, respectively, precluding a thorough analysis of short- and long-term efficacy, safety and predictors of success.”
Investigators searched the literature for cohort studies of adults with CD and strictures of the stomach or duodenum who underwent endoscopic balloon dilation (94 patients underwent 141 balloon dilations) through December 2016. They assessed mechanical and clinical success of the procedure and performed event analysis to explore symptom recurrence and need for re-dilation or surgery.
Bettenworth and colleagues determined that the rate of technical success for endoscopic balloon dilation was 100%, while the short-term clinical success was 87%. They found that major complications came from 2.9% of all procedures.
In a median follow-up period of 23.1 months, 70.5% of patients had recurrence of symptoms, 59.6% had to undergo re-dilation and 30.8% required surgery. Researchers also explored risk factors for all three outcomes and found that patients with disease located in the small bowel had a higher risk for symptom recurrence (HR = 2.1; P = .003). Asian race (HR = 2.8; P < .001) and disease in the small bowel (HR = 1.9; P = .004) increased the need for re-dilation, and prestenotic dilation (HR = 1.9; P = .001) was a risk factor for earlier need for surgery.
“The results of this largest multicenter evaluation of EBD for CD-associated strictures of the upper GI tract, demonstrate high rates of short-term technical and clinical success,” Bettenworth and colleagues wrote. “Given the moderate long-term efficacy and acceptable complication rate, EBD is a valuable treatment option in patients with stricturing CD of the upper GI tract when contraindications such as abscess, fistula, phlegmon, dysplasia, or malignancy have been excluded.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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