The Efficacy and Safety of Endoscopic Balloon Dilation in the Treatment of Stricturing Crohnʼs Disease

Abstract

Purpose: To assess the efficacy and safety of endoscopic balloon dilation (EBD) for the treatment of Crohn's disease (CD)-related strictures in a tertiary care population. Methods: All patients who underwent EBD for the treatment of stricturing CD from 2005 through 2012 were identified. Demographic and clinical information were obtained from a clinical data repository and from review of medical records. A technically successful dilation was defined as the ability to traverse a stricture following EBD. Primary outcomes assessed included the technical success rate of EBD, the percent of EBD-treated patients who required further endoscopic or surgical therapy, and complications of EBD. Results: Seventy-five CD patients underwent 131 dilations on 83 strictures. The average patient age was 25+/-11 years. Sixty percent of patients were women, and 68% were Caucasian. Sixty percent, 28%, and 12% had ileocolonic, ileal, and colonic disease location, respectively. Forty-seven percent, 44%, and 9% had penetrating, stricturing, and inflammatory disease behavior, respectively. The majority of treated strictures were located at a surgical anastomosis (69%), with the ileocolonic location being the most common site. Technical success rate of EBD was 70%. Factors associated with technical success included maximum balloon diameter of 18 mm and non-Caucasian race. Forty-nine percent of patients underwent repeat EBD an average of 3 months after the first dilation. Maximum balloon diameter of 18 mm, female gender, non-Caucasian race, and use of concurrent immune suppressant were negatively associated with repeat EBD. Eighty percent of patients underwent surgical resection an average of 8 months after EBD. Inflammatory-type strictures, anastomotic-type strictures, ileal disease location, male gender, and lack of obstructive symptoms were negatively associated with resection after EBD. Complications occurred after three procedures (2%), including admissions for post-procedure pain, bleeding, and microperforation. Surgery was not required as a result of any complication. Conclusion: EBD was technically successful in the majority of CD patients; however, 80% underwent surgical resection less than a year after EBD. Inflammatory-type strictures, anastomotic-type strictures, ileal disease, male gender, and lack of obstructive symptoms were negatively associated with stricture resection after EBD; thus, EBD in CD patients with these features may have better long-term outcomes. EBD was safe, with only 2% of patients experiencing procedure-related complications. Providers should consider EBD to delay or prevent surgery in CD patients.