Endoscopic balloon dilation safe, provides longer symptom-free survival in CD stenosis
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Endoscopic balloon dilation was more effective than fully covered self-expandable metal stents for Crohn’s disease strictures, according to a study published in The Lancet Gastroenterology & Hepatology.
“Our findings suggest that [endoscopic balloon dilation (EBD)] is more effective than [fully covered self-expandable metal stents for Crohn’s disease strictures (FCSEMS)], with fewer patients in the EBD group requiring an intervention for symptomatic recurrence at 1 year than in the FCSEMS group, with an equally good safety profile,” Carme Loras, PhD, of the University of Barcelona, and colleagues wrote.
Loras and colleagues conducted a multicenter, randomized trial of 80 CD patients in Spain with obstructive symptoms and predominantly fibrotic strictures less than 10 cm in length. Participants received either EBD with a CRE Boston Scientific pneumatic balloon or FCSEMS with the placement of a 20 mm Taewoong metal stent.
The efficacy of each treatment was determined by the proportion of patients who did not have a new therapeutic intervention, including EBD, FCSEMS or surgery, because of symptomatic recurrence at 1 year. Secondary outcomes included symptom-free survival, safety and mean costs.
Thirty-nine patients (mean age, 43 years; 59% women) received FCSEMS and 41 patients (mean age, 47 years; 39% women) received EBD. At the 1-year follow-up, 80% of patients in the EBD group were free of therapeutic intervention as a result of symptomatic recurrence vs. 51% of patients in the FCSEMS group (OR = 3.9; 95% CI, 1.4-10.6; P = .0061). In addition, 80% of the patients in the EBD group had longer symptom-free survival vs. 51% in the FCSEMS group (HR = 0.32; 95% CI, 0.14-0.73; P = .0043). Five adverse events were recorded, two of which were perforations (one from each group).
Further, analysis revealed that the mean cost of treatment was lower per patient in the EBD group compared with the FCSEMS group.
“Our data suggest that EBD should be the first choice for the endoscopic treatment of Crohn’s disease strictures,” Loras and colleagues concluded.
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