Efficacy and Safety of Endoscopic Balloon Dilation for Upper Gastrointestinal Strictures of Crohn’s Disease

Guo, Fan; Huang, Yuhua; Zhu, Weiming; Wang, Zhiming; Cao, Lei; Chen, Aoxue; Guo, Zhen; Yi, Li; Gong, Jianfeng; Li, Jieshou

doi:10.1007/s10620-016-4242-y

Cited by 24 publications

(11 citation statements)

References 30 publications

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“…Two recent studies on dilation of de novo upper gastrointestinal strictures associated with CD showed a technical success rate of 93% and an overall complication rate of 3–4%. EBD delayed the need for surgery in about 56–66% of patients over a median follow‐up of 23 to 24 months . Similarly, emerging data from retrospective studies, revealed that double‐balloon endoscopy‐assisted EBD provided a reasonable technical success rate (72% to 100%), short‐term efficacy (about 70%), and safety (complication rate of 0% to 10%) in patients with small intestinal CD‐associated de novo strictures.…”

Section: Management Of Crohn's Disease Associated Stricturesmentioning

confidence: 98%

Crohn's disease associated strictures

Chan

Mourad

Leong

2018

J of Gastro and Hepatol

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Crohn's disease (CD) is a chronic relapsing and remitting disease that can affect any segments of the gastrointestinal tract. More than 50% of patients with CD develop stricturing or penetrating complications within the first 10 years after diagnosis. Strictures can lead to intestinal obstruction, which is a common indication for surgery. Despite significant advances in the understanding of the pathogenesis of intestinal fibrostenosis, imaging and therapeutic armamentarium of CD, the risk of intestinal surgery remained significantly high. Endoscopic balloon dilation is a promising first-line alternative to surgery as it is less invasive and could preserve intestinal length. In this review, we will evaluate the literature on the mechanism of intestinal fibrosis, emerging imaging techniques, and management strategies for CD associated strictures.

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Section: Management Of Crohn's Disease Associated Stricturesmentioning

confidence: 98%

Crohn's disease associated strictures

Chan

Mourad

Leong

2018

J of Gastro and Hepatol

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“…In general, there is a high rate of recurrence of obstructive symptoms, and repeated dilatations are required to treat them properly and avoid surgery[50,103]. A retrospective study by Guo et al[104] evaluated the safety and efficacy of endoscopic balloon dilations for the treatment of stenoses in 24 patients with gastroduodenal DC associated with obstructive symptoms, less than 4 cm, not associated with fistulas or abscesses. They demonstrated that the procedure was safe but had unfavorable long-term effectiveness.…”

Section: Treatmentmentioning

confidence: 99%

Crohn’s disease of esophagus, stomach and duodenum

Pimentel

Rocha

Santana

2019

WJGPT

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Crohn’s disease with involvement of the esophagus, stomach and duodenum has a prevalence of 0.5% to 4% in symptomatic adult patients, but some studies have shown that these results may be underestimated, since upper gastrointestinal endoscopy is not performed routinely in the initial evaluation of the disease in adult patients, as it is in the pediatric population. In general, involvement of the upper gastrointestinal tract in Crohn’s disease occurs concomitantly with involvement of the lower gastrointestinal tract. The diagnosis depends on clinical, endoscopic, histological and radiological evaluation. The presence of aphthoid ulcers, longitudinal ulcers, bamboo-joint-like appearance, stenoses and fistulas are endoscopic findings suggestive of the disease, and it is important to exclude the presence of Helicobacter pylori infection. The primary histological findings, which facilitate the diagnosis, are the presence of a chronic inflammatory process with a predominance of lymphoplasmacytic cells and active focal gastritis. The presence of epithelioid granuloma, although less frequent, is highly suggestive of the disease in the absence of chronic granulomatous disease. Treatment should include the use of proton pump inhibitors associated with corticosteroids, immunomodulators and biological therapy according to the severity of the disease.

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“…The definitions used for the explored parameters of included studies [16][17][18][19] are reported in the Supplementary Materials and Methods section and Supplementary Table 1.…”

Section: Data Collectionmentioning

confidence: 99%

“…There were 141 total dilation procedures. Seventy patients undergoing 112 dilations have been published in multiple individual smaller series previously, [16][17][18][19][20][21] and 24 patients undergoing 29 dilations were not in previously published reports but were added through our multicenter collaboration ( Table 1). The demographics of this population are shown in Table 2.…”

Section: Pooled Individual Patient Analysismentioning

confidence: 99%

Efficacy of Endoscopic Dilation of Gastroduodenal Crohn’s Disease Strictures: A Systematic Review and Meta-Analysis of Individual Patient Data

Bettenworth

Mücke

López

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Little is known about the effects of endoscopic balloon dilation (EBD) for strictures of the upper gastrointestinal (UGI) tract in patients with Crohn's disease (CD). We performed a pooled analysis of the efficacy and safety of EBD for UGI CD-associated strictures. METHODS: We searched Embase, Medline, and the Cochrane library, as well as bibliographies of relevant articles, for cohort studies of adults with CD and strictures of the stomach or duodenum (up to the ligament of Treitz) who underwent EBD through December 2016. We obtained data from 7 international referral centers on 94 patients who underwent 141 EBDs. We performed a patient-level meta-analysis of data from published and unpublished cohort studies to determine mechanical and clinical success. We performed a time-to-event analysis to assess symptom recurrence and need for redilation or surgery. The patients analyzed had strictures of the duodenum (n [ 107), stomach (n [ 30), or spanning both (n [ 4). RESULTS: The rate of technical success for EBD was 100%, with 87% short-term clinical efficacy; major complications arose from 2.9% of all procedures. During a median follow-up period of 23.1 months, 70.5% of patients had a recurrence of symptoms, 59.6% required redilation, and 30.8% required surgical intervention. Patients whose disease was located in the small bowel had a higher risk for symptom recurrence (hazard ratio [HR], 2.1; P [ .003). Asian race (HR, 2.8; P < .001) and location of disease in the small bowel (HR, 1.9; P [ .004) increased the need for redilation. Prestenotic dilation was a risk factor for needing surgery earlier (HR, 1.9; P [ .001).

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Efficacy and Safety of Endoscopic Balloon Dilation for Upper Gastrointestinal Strictures of Crohn’s Disease

Abstract: EBD was a safe procedure, but not a potent therapy for Crohn's upper GI strictures. Meanwhile, 1-month response could serve as an early predictor of the long-term response.

Cited by 24 publications

References 30 publications

Crohn's disease associated strictures

Crohn's disease associated strictures

Crohn’s disease of esophagus, stomach and duodenum

Efficacy of Endoscopic Dilation of Gastroduodenal Crohn’s Disease Strictures: A Systematic Review and Meta-Analysis of Individual Patient Data

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