Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: A systematic review

Baars, Jan; Theyventhiran, Ruben R.; Aepli, Patrick; Saxena, Payal; Kaffes, Arthur J.

doi:10.3748/wjg.v23.i45.8073

Cited by 37 publications

(28 citation statements)

References 29 publications

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“…The success rate of these EBD procedures was 84%, and the long-term prevention of surgery following EBD was 67.2%. These findings in agreement with success rates, [6,10,11] and surgery free survival [12–14] reported by others. Two recent meta-analyses reported an 89% technical success rate of EBD procedures among CD patients.…”

Section: Discussionsupporting

confidence: 93%

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Winder

Fliss-Isakov²,

Winder³

et al. 2019

Medicine

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Intestinal strictures are common complications of Crohn's disease (CD). Endoscopic balloon dilatation (EBD) constitutes an alternative therapy to surgery, but associated factors of procedure success are inconclusive. Therefore, we aimed to evaluate the EBD success rate and its associated factors in CD patients.This is a retrospective cohort study of consecutive EBDs that were conducted between 2006 and 2014 among patients with CD with lower gastrointestinal tract strictures. Patients’ and stricture characteristics, short term procedure success and related complications at 1 week follow-up, and long-term clinical endpoints were documented.A total of 138 dilatations were performed on 64 CD patients. The overall dilatation success rate was 84.8%, with no difference between primary or anastomotic strictures, or between first or recurrent dilatation procedures. Long strictures (≥4 cm) were negatively associated with successful EBDs, but not with perforations. A multivariate analysis adjusting for age, sex, smoking, and disease duration revealed that a maximal dilatation diameter of ≥15 mm was positively associated with a successful EBD, while an inflamed stricture was negatively associated with procedure success. Strictures which were both long and inflamed were associated with the lowest EBD success rates compared with other strictures. Only 32.8% of patients required surgery during the follow-up period. Long-term prevention of surgery was negatively associated with stricture length and with a successful EBD.EBD is highly successful in treating intestinal strictures and in prevention of surgery in CD patients. Although EBD of long strictures is safe, it will not prevent surgery in the majority of cases.

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Section: Discussionsupporting

confidence: 93%

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Winder

Fliss-Isakov²,

Winder³

et al. 2019

Medicine

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“…They also reported that successful EBD cases showed significantly higher surgery-free rates than unsuccessful cases using the Kaplan-Meier method. In a systematic review of 13 published articles, Baars et al [17] reported on the efficacy and safety of EBD for small-bowel strictures in both CD and non-CD cases. In their study, the average follow-up time was 31.8 months per patient and the complication rate was 4.8% per patient.…”

Section: Discussionmentioning

confidence: 99%

Experience with Balloon Dilatation in Crohn’s and Non-Crohn’s Benign Small-Bowel Strictures: Is There a Difference?

Tsuboi

Oka

Tanaka

et al. 2019

Gastroenterology Research and Practice

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Background/Aim. Endoscopic balloon dilation (EBD) has been effective for small-bowel strictures in patients with Crohn’s disease (CD). However, its efficacy and indication for small-bowel strictures in non-CD patients have not been established. This study evaluated the clinical efficacy and safety of EBD for small-bowel strictures in non-CD patients compared with CD patients. Methods. Ninety-eight consecutive patients (mean age, 53 years; average observation period, 45 months) with small-bowel strictures diagnosed by double-balloon endoscopy were retrospectively evaluated at Hiroshima University Hospital from August 2003 to April 2017. The average number of procedures, short-term and long-term EBD success rates, and safety profiles between the non-CD and CD groups were examined. Results. Surgery was selected as the initial treatment in 44 cases (45%) (non-CD group, 27 (61%); CD group, 17 (39%)) as EBD is not indicated. Fourteen non-CD patients had strictures due to malignant tumors, while 13 patients had benign strictures. Twenty-three patients (non-CD, 12; CD, 11) underwent EBD. Forty-three EBD procedures were performed for 17 stricture sites (average: 2.5 procedures/site) in non-CD patients and 41 EBD procedures for 18 stricture sites (average: 2.3 procedures/site) in CD patients. The short-term success rate was 100% (23/23), whereas the long-term success rate was 92% (11/12) in non-CD patients and 82% (9/11) in CD patients. No significant differences in the surgery-free rate occurred between both groups. Furthermore, one adverse event, bleeding after EBD, was encountered in the non-CD group (8%, 1/12). Conclusion. EBD for small-bowel strictures demonstrated good clinical outcomes in non-CD patients.

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“…In experienced hands the technical feasibility is over 90%, which is equivalent to conventional endoscopic balloon dilation for colon and ileocolonic anastomoses [69]. Dilation of anastomotic or primary strictures, shorter than 5 cm, non-angulated and without significant inflammatory activity namely deep ulcers or fistulae, proved to be safe and associated with better long-term outcomes [69,70,[76][77][78]. Data on adjunctive therapies for refractory strictures, such as triamcinolone or infliximab injection, stent placement or cutting techniques are scarce and mixed, currently not supporting their routine use.…”

Section: Crohn's Diseasementioning

confidence: 99%

“…DAE has also been used for therapy: retrieval of potentially harmful foreign bodies, especially retained CE [125], but also bezoars [126], needles [127], coins [128], gastric bands [129], dentures [130] and migrated stents [131]. Many SB strictures secondaries to NSAIDs, radiation, surgical anastomosis, or malignancy have been treated with balloon dilation [76,132,133] or stenting, using both over-the-wire or through-the-scope techniques [134][135][136]. DAE can also be used for percutaneous endoscopic jejunostomy [137] and SB intussusception [138].…”

Section: Miscelaneousmentioning

confidence: 99%

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

Pérez-Cuadrado-Robles

Pinho

González

et al. 2020

GE Port J Gastroenterol

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The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.

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Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: A systematic review

Cited by 37 publications

References 29 publications

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Experience with Balloon Dilatation in Crohn’s and Non-Crohn’s Benign Small-Bowel Strictures: Is There a Difference?

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

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