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Abstract
IntroductionStricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce.MethodsA retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients.ResultsOut of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn’s disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1–5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons.ConclusionNon-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.
Highlights
Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention
Patients with confirmed diagnosis of Crohn’s disease, suspected or proven malignancy and those with imminent need for surgery because of non-relenting obstruction were excluded from the study
Endoscopic details like timing of endoscopic balloon dilatation (EBD) with respect to ATT duration, number of endoscopic dilatation sessions required, maximum dilatation required for symptomatic relief, adverse events of dilatation and need for surgery were recorded
Summary
Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce. It is important to differentiate clinically relevant strictures (i.e. those causing symptoms) from those which may only be morphological without any functional impairment [4]. It has been noted in different studies that the clinical response and radiologic responses have different implications [5,6,7,8]. While the clinical symptoms may respond to antitubercular therapy (ATT), the radiological strictures may respond only partially [6, 8]. Surgery may be needed in cases where the stricture is either not endoscopically accessible or does not respond to dilatation
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