Long-Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn's Disease

Abstract

Background: Gastrointestinal stricture is the most often and serious complication in Crohn's disease. Because of the frequent post-operative recurrence in Crohn's disease, endoscopic therapy of gastrointestinal stricture is one of the best therapeutic options. Method: The present study sets out the results from a prospective study of endoscopic balloon dilation (EBD) therapy on 68 Crohn's disease patients with severe gastroduodenal (n = 9) and intestinal (n = 59) stenoses who had an upper or lower GI-tract obstructive symptoms. EBD session was undertaken using through the scope balloon for a few times in a session. All patients who could not undergo EBD were operated on. Results: Thirteen patients were operated on in 6 months after the initial EBD. Long-term (>6 months) success was attained in 55 (9 gastroduodenal and 46 intestinal stenoses) of the 68 patients and 30 patients avoided surgery; There were no differences in gender, age at dilation, suffering period before dilation, anastomotic site stenosis/non-anstomotic stenosis and length of stenosis between patients who were operated and patients who were not operated. Average observation period in non-operated patient and operated patients was 84.3 months and 34.4 months, respectively. Cumulative avoidance of surgery after EBD was 87% at one year, 67% at three and 59% at five. Second, There was no significant difference in avoidance of surgery rate between the patients with gastroduodenal stenosis (90% at one year and 78% at three and five years) and intestinal stenosis (86% at one year, 77% at three and 55% at five). Thirdly, the most hazardous factor was recurrent inflammation causing restenosis. Patients who had strictures with oral luminal dilatation and patients with frequent recurrence had a tendency to be operated on. As a complication, perforation occurred in two cases (3.3%). Conclusions: EBD therapy for Crohn's stricture in the gastrointestinal tract is recommended before surgical intervention. Background: Gastrointestinal stricture is the most often and serious complication in Crohn's disease. Because of the frequent post-operative recurrence in Crohn's disease, endoscopic therapy of gastrointestinal stricture is one of the best therapeutic options. Method: The present study sets out the results from a prospective study of endoscopic balloon dilation (EBD) therapy on 68 Crohn's disease patients with severe gastroduodenal (n = 9) and intestinal (n = 59) stenoses who had an upper or lower GI-tract obstructive symptoms. EBD session was undertaken using through the scope balloon for a few times in a session. All patients who could not undergo EBD were operated on. Results: Thirteen patients were operated on in 6 months after the initial EBD. Long-term (>6 months) success was attained in 55 (9 gastroduodenal and 46 intestinal stenoses) of the 68 patients and 30 patients avoided surgery; There were no differences in gender, age at dilation, suffering period before dilation, anastomotic site stenosis/non-anstomotic stenosis and length of stenosis between patients who were operated and patients who were not operated. Average observation period in non-operated patient and operated patients was 84.3 months and 34.4 months, respectively. Cumulative avoidance of surgery after EBD was 87% at one year, 67% at three and 59% at five. Second, There was no significant difference in avoidance of surgery rate between the patients with gastroduodenal stenosis (90% at one year and 78% at three and five years) and intestinal stenosis (86% at one year, 77% at three and 55% at five). Thirdly, the most hazardous factor was recurrent inflammation causing restenosis. Patients who had strictures with oral luminal dilatation and patients with frequent recurrence had a tendency to be operated on. As a complication, perforation occurred in two cases (3.3%). Conclusions: EBD therapy for Crohn's stricture in the gastrointestinal tract is recommended before surgical intervention.