Efficacy and safety of endoscopic balloon dilation of symptomatic intestinal Crohn's disease strictures

Scimeca, Daniela; Mocciaro, Filippo; Cottone, Mario; Montalbano, Luigi; D’Amico, Gennaro; Olivo, Mirko; Orlando, R.; Orlando, Ambrogio

doi:10.1016/j.dld.2010.05.001

Cited by 70 publications

(76 citation statements)

References 29 publications

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“…In this study, patients without stenotic symptoms were included as subjects, and the maximum observation period after EBD was only 3 years. Therefore, the cumulative surgery-free rate was approximately 70% at 3 years, similar to the results of previous studies (17)(18)(19)(20)(21)(22)(23)(24)(25)32). The cumulative rate of surgery in CD reportedly ranges from 46% to 62% at 5 years and from 61% to 75% at 10 years.…”

Section: Discussionsupporting

confidence: 77%

“…The incidence of perforation is reportedly 0-9%, and this complication accounts for 5-25% of all cases with serious complications (17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)33). In this study, portal emphysema developed in one patient (34); this complication was apparently attributable to the excessive CO 2 gas insufflation at the time of scope insertion, in addition to a pre-existing tendency for intestinal gas retention.…”

Section: Discussionmentioning

confidence: 99%

“…EBD is an alternative to surgery in CD cases with intestinal stenosis. The use of EBD for the stenotic lesions of CD has been reported since the 1990s, with the procedure being conducted using an upper gastrointestinal endoscope or colonoscope mainly for the stenosis in the upper gastrointestinal tract, in the large intestine, or at the anastomotic site (17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…Advancements in endoscopic techniques and drug therapy, especially biological products, have enabled endoscopic dilation to be applied for intestinal stenosis in patients with CD, followed by enhanced medical treatments and the postponement or even avoidance of surgery (17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

Kanamori

Sugaya²,

Tominaga³

et al. 2017

Turk J Gastroenterol

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Background/Aims: Endoscopic balloon dilation (EBD) can serve as an alternative to surgery for intestinal stenosis associated with Crohn's disease (CD). However, there has been controversy regarding the efficacy and safety of EBD. Here we sought to determine the therapeutic efficacy and safety of EBD for intestinal stenosis in CD. Materials and Methods: Of 43 patients with CD accompanied by intestinal stenosis, 30 underwent EBD. These 30 patients were examined retrospectively in terms of the scope passage rate, surgery-free rate, and whether or not the observation of the distal intestinal tract influenced the therapeutic strategy. Results: The overall scope passage and surgery-free rates were 90.0% and 76.7%, respectively. There were no statistically significant differences in the site of the dilated intestinal tract among groups. Patients who had inflammation in the distal intestinal tract alone after EBD accounted for 56.7%. The rate of re-dilation was 46.7%, and time until re-dilation was 6.6±3.6 months. Conclusion: EBD was associated with favorable short-term and long-term outcomes and good safety. Observation of the distal intestinal tract influenced the decision-making process for therapeutic strategies. The results of this study suggest that EBD may allow the postponement or even avoidance of surgery, enabling not only intestinal dilation but also the evaluation of mucosal healing to be performed. Thus, EBD is considered to be an effective alternative treatment for intestinal stenotic lesions in patients with CD.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

Kanamori

Sugaya²,

Tominaga³

et al. 2017

Turk J Gastroenterol

View full text Add to dashboard Cite

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“…Whereas some authors showed an efficacy for the association between budesonide and azathioprine during 1 year following the procedure, with a 20 % rate of symptomatic recurrence [87], others reported that azathioprine alone does not substantially modify the patient outcome after endoscopic dilation, with a 41 % rate of symptomatic recurrence with a mean follow-up of 29 months [88]. Age and disease location (jejunal or ileal) appeared to be the strongest predictors of stricturing complications.…”

Section: Medical Therapymentioning

confidence: 95%

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

et al. 2014

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Crohn's disease (CD) is a chronic inflammatory bowel disease that can involve virtually any part of the gastrointestinal tract. CD complications are the main indications for surgery. A large proportion of these interventions are due to stricturing disease. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD. Unfortunately, surgery is not curative, as the disease ultimately reoccurs in a substantial subset of patients. To best identify the patients who will require a specific treatment and to plane the most appropriate therapeutic approach, it is important to precisely define the type, the size, and the location of CD stenosis. Diagnostic approaches aim to distinguish fibrotic from inflammatory strictures. Medical therapy is required for inflammatory stenosis. Mechanical treatments are required when fibrotic CD strictures are symptomatic. The choice between endoscopic balloon dilation, stricturoplasty, and laparoscopic or open surgery is based on the presence of perforating complications, the remaining length of small bowel, and the number and length of strictures. The non-hierarchical decision-making process for the treatment of fibrotic CD therefore requires multidisciplinary clinical rounds with radiologists, gastroenterologists, interventional endoscopists, and surgeons.

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