BACKGROUND
Endoscopic balloon dilation (EBD) is an effective method for treating
stricture-related obstruction in Crohn’s disease (CD). We aimed to
identify factors predictive of successful avoidance of surgery, including
endoscopic features, in patients undergoing balloon dilation.
METHODS
We performed a retrospective review of patients with symptomatic
CD-related intestinal strictures undergoing EBD. Clinical, medication use,
laboratory, and dilation data, including the minimum and maximum balloon
sizes used, and number of balloons used per endoscopic session were
collected. Multivariate analysis by Cox proportional hazard regression was
used to model future surgical bowel resection.
RESULTS
In a total of 135 subjects undergoing 292 dilations, multivariate
modeling demonstrated that failure to achieve a maximum dilation of 14mm or
more increased the risk of surgery (HR 2.88, 95%CL 1.10,7.53). While
there was no difference in the risk of future surgery between maximum EBD
sizes of 14–15mm and 16–18mm, those reaching 16–18mm
exhibited a longer interval between subsequent dilations (mean
240±136.7 vs. 456±357.3 days, respectively,
p=0.023). Endoscope passage at index dilation was not predictive of
future surgery (HR 0.63 95%CL 0.31, 1.26). Adjusting for covariates
of EBD size, stricture location and type, a CRP>1.5mg/dL (HR 2.60,
95%CL 1.12, 5.94) and anti-TNF initiation following index EBD (HR
2.39, 95%CL 1.09, 5.25) increased the risk of future surgery.
CONCLUSIONS
While dilation calibers larger than 14–15mm were not more
protective against future surgery, those reaching 16–18mm underwent
maintenance dilation less frequently. The risk of surgery associated with
post-EBD anti-TNF initiation suggests effective therapy is often employed
too late in the disease course.