Mucosal Healing can Promote Favorable Outcome in Patients with Crohnʼs Disease after Enteroscopic Dilatation of the Small Intestinal Stenosis

Abstract

Purpose: Enteroscopic dilatation of the small intestinal stenosis in patients with Crohn's disease (CD) may avoid surgical operation, but restenosis is not uncommon as far as active mucosal lesion is present. Attainment of mucosal healing (MH) generally anticipates a favorable prognosis in patients with CD. Restenosis after enteroscopic dilatation may be prevented by attaining MH. The purpose of this study is to assess whether MH can promote favorable outcome after enteroscopic dilatation of small intestinal stenosis in patients with CD. Methods: In 14 CD patients with small intestinal stenosis who received anti-TNF therapy, enteroscopy was performed in attempt to dilate 29 stenotic lesions. Among 29 lesions, enteroscopic dilatation was not technically feasible for 3 lesions, and enteroscopic dilatation was performed for 26 stenotic lesions without serious complications. In these 26 lesions, MH defined by Rutgeer score 1 or less was confirmed in 14, whereas MH was not noted in the remaining 12. Time interval between enteroscopic dilatation and restenosis was assessed. Average follow-up period was 22.5 months. Results: 10 patients (71%) developed clinical features of recurrent stenosis, and underwent enteroscopy which revealed 13 stenotic lesions. Enteroscopic dilatation was performed again, and only 1 patient (7.1%) required surgical intervention. Average interval between enteroscopic dilatation and restenosis was significantly longer for 14 lesions with MH, compared with 12 lesions without MH (15.4 vs. 6.7 months: Logrank test P<0.05). Conclusion: Enteroscopic dilatation can be successfully performed in the majority of the patients with CD, and potentially avoid surgical operation. MH of the stenotic lesions may promote a favorable outcome after endoscopic dilatation in patients with CD.