Prognostic factors, effectiveness and safety of endoscopic balloon dilatation for de novo and anastomotic strictures in Crohn’s disease—A multicenter “real life” study

Renáta Bor,Klaudia Farkas,Ágnes Milassin,Dalma Törőcsik,Zoltán Szepes,Anna Fábián,Mariann Rutka,Ferenci Tamás,Ferenc Nagy,Tamás Molnár,Károly Palatka,Anita Bálint,Mónika Szűcs

doi:10.1080/2331205x.2016.1233687

Renáta Bor, Klaudia Farkas + Show 11 more

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https://doi.org/10.1080/2331205x.2016.1233687

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Abstract

AbstractIntroduction: Crohn’s disease (CD) is a chronic inflammatory disease which is frequently complicated by obstructive symptoms secondary to development of intestinal strictures. The aim of this “real life” study was to assess the effectiveness, safety and outcome of endoscopic balloon dilatation (EBD) in de novo vs. anastomotic stenoses. Patients and methods: Data of 93 EBDs in 46 CD patients were retrospectively analyzed. Technical success rate was defined as the ability of endoscope to traverse the stenosis after dilatation. Long-term clinical success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilatation following the technical success. Results: About 62.4% of strictures were de novo and 37.6% anastomotic. The elapsed time between diagnosis and the first balloon dilatation was 9.5 (0–35) years. About 73.1% of dilatations were successful over a short-term period without serious complications. About 47.8% of patients showed that EBD is effec...

Highlights

Crohn’s disease (CD) is a chronic inflammatory disease which is frequently complicated by obstructive symptoms secondary to development of intestinal strictures
endoscopic balloon dilatation (EBD) in stricturing CD is generally performed in the colon and terminal ileum, advanced techniques like single and double-balloon endoscopy facilitate the access to more oral regions of the small bowel
The outcomes of medical treatment of stricturing CD are poor due to the reduced ability to control the progress of fibrosis (Samimi, Flasar, Kavic, Tracy, & Cross, 2010), and the risk of recurrence after intestinal resection is high, the management of de novo and postoperative intestinal strictures is a relevant issue (Greenstein, Sachar, Pasternack, & Janowitz, 1975; Rutgeerts et al, 1990)

Summary

Introduction

Crohn’s disease (CD) is a chronic inflammatory disease which is frequently complicated by obstructive symptoms secondary to development of intestinal strictures. The aim of this “real life” study was to assess the effectiveness, safety and outcome of endoscopic balloon dilatation (EBD) in de novo vs anastomotic stenoses. Despite the advances in the medical therapy of inflammatory bowel diseases, intervention is necessary in the majority of stricturing CD cases as showed by the data in the literature: up to 80% of patients require surgery within 10 years after the diagnosis and the cumulative rate of surgery after 10 years is 64% (Nanda et al, 2013; Wibmer, Kroesen, Gröne, Buhr, & Ritz, 2010). A technical success rate of 71–100% and a major complication rate of 0–18% have been reported with EBD (Wibmer et al, 2010)

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