Endoscopic balloon dilation in the management of strictures in Crohn's disease: a systematic review and meta-analysis of non-randomized trials.

Abstract

Crohn's disease (CD) is associated with strictures. Endoscopic balloon dilatation (EBD) may prevent or delay the need for surgical resection. The aim of this systematic review was to determine the efficacy and safety of EBD in the management of Crohn's strictures. A comprehensive search of MEDLINE and EMBASE databases from January 1980 to May 2015 was performed. The primary outcome measurements were surgical intervention rates and major adverse events. A total of 24 studies involving 1163 patients were included in the analysis. The median duration from the initial diagnosis of CD to the first EBD was 10.2-17.0years. The majority of strictures (69%) treated were anastomotic, while the remaining strictures were naive (primary). Surgical intervention rate over a median follow-up period of 15-70months in the reported studies was 27%. The surgical intervention rate after dilation of anastomotic strictures was 18% versus 29% for primary strictures. The risk ratio for the surgical requirement of anastomotic versus primary strictures was [0.88 (95% confidence interval [CI] 0.59-1.32); p=0.54]. Stricture length <4cm was associated with a significantly decreased risk of surgical intervention [risk ratio=0.48 (95% CI 0.26-0.90); p=0.02]. EBD resulted in major adverse events in 4% of the patients. EBD appears to be a safe alternative for surgery in the management of Crohn's strictures. Stricture length <4cm treated with EBD is associated with a significantly decreased risk of surgical intervention.