Endoscopic balloon dilatation of Crohn's strictures: a safe method to defer surgery in selective cases

Abstract

EBD is safe for both primary and post-surgical strictures. Stricture length and diameter of dilatation are predictive of success. In selected patients, treatment with EBD may reduce or delay the need for surgery.

Efficacy of drug and endoscopic treatment of Crohn's disease strictures: A systematic review

“…Multiple predictors of treatment success were identified from the 60 endoscopic therapy studies. The most consistent predictor of treatment success was stricture length 22,47,48,52,58 . However, few studies included patients with strictures longer than 5 cm.…”

“…Other medications explored in combination with EBD included antibiotics that were found to be linked with an increased likelihood of reintervention in one study 69 and concomitant corticosteroids that were associated with repeated intervention in two studies 47,58 …”

Guidelines for endoscopic balloon dilation in treating Crohn's disease‐associated small intestinal strictures (supplement to the Clinical Practice Guidelines for Enteroscopy)

“…In a retrospective study limited to small intestinal lesions, the rate of avoiding resection improved with dilation of 15 mm or greater in a univariate analysis 4 . Another retrospective study that included both small intestinal and colonic lesions reported improved outcomes with dilation of 12–15 mm or 5–8 greater. In a retrospective study including both small intestinal and colonic lesions using colonoscopy, no significant difference was found in procedure risk between diameters of 14–15 mm and 16–18 mm; however, the group that selected the dilation diameter of 16–18 mm had a longer dilation interval after the fourth dilation (mean 240 ± 136.7 days vs. 456 ± 357.3 days, P = 0.023) 7 …”

“…The scope of the term “efficacy” is equally broad, ranging from avoiding surgery or the need for repeated EBD to the complete absence of recurrent abdominal symptoms caused by GI tract strictures. When measured by the rate of preventing the need for a repeated EBD (some overlap was detected), the long‐term efficacy rate is reported to be 46–93% 1–17 . The post‐EBD surgical conversion rate can be considered the most important long‐term efficacy indicator.…”

“…Previous studies have reported short‐term efficacy rates ranging between 36% and 100%, particularly when efficacy was defined as the endoscope being able to pass through the stricture or disappearance of abdominal symptoms caused by the stricture (disappearance of abdominal pain, post‐EBD food intake, etc.) 1–17 . Regarding long‐term efficacy, the definition of “long‐term” differs among reports (the average period of observation was 6–10 months).…”