Long-Term Outcome of Endoscopic Balloon Dilatation for Strictures in Patients with Crohn’s Disease

Abstract

Background/Aims: Endoscopic balloon dilatation (EBD) is an alternative to surgery for strictures in patients with Crohn’s disease (CD). The aim of the present study was to clarify the efficacy and safety of EBD for strictures in patients with CD. Methods: Twenty-six patients with CD who underwent EBD for strictures from August 2008 to November 2015 were followed up after dilatation. Short-term success was defined as the disappearance of obstructive symptoms after technically adequate dilatation was achieved. The short-term success rate of EBD, safety profile of EBD, and cumulative surgery-free and redilatation-free rates were analyzed. Results: Sixty-five EBDs were performed for CD patients in the follow-up period. The short-term success rate was 100% (26/26), and no complications were encountered during this study. Two (7.7%) patients underwent surgery during the observation period. The cumulative surgery-free rate after the initial EBD was 90.3% at both 2 and 3 years. The cumulative redilatation-free rate after the initial EBD was 52.1% at 2 years and 39.1% at 3 years. Conclusion: EBD for strictures secondary to CD provides not only short-term success but also long-term efficacy. Although a high redilatation rate is one of the clinical problems of this procedure, EBD is an effective therapy for avoiding intestinal recession in CD ­stricture.

Doppler Activity and Ultrasonographic Detection of Intra-Abdominal Fistulas Are Predictors of Surgery in Crohn’s Disease

“…Nonresponse to medical or endoscopic therapies (or if endoscopic dilation is not feasible) is the main indication for surgery in stricturing disease [17]. Clinical features suggesting a poor prognosis in CD are well known [18] but no predictors for surgery have been established, and literature on the subject is limited.…”

Therapeutic Endoscopy in Postoperative Pouch Complications

“…EBD has been extensively used to treat fibrostenotic strictures of the pouch or nonpouch CD, 16 17 18 19 20 21 and has emerged as a safe and effective treatment modality. Navaneethan et al performed a meta-analysis of 13 studies, including 1,163 patients with CD who underwent EBD.…”

The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021

“…Although the overall complication rate was 5%, there were no perforations and only 1 patient needed surgical intervention within the follow-up period [ 139 ]. The apparent trend is that long-term EBD outcomes are improving as experience, enteroscopes and accessories are further refined [ 140 , 149 ]. Among 85 patients with SB strictures due to CD, who underwent a total of 473 successful EBDs, the overall surgery-free rate was 87.3% after 1 year, 78.1% after 3 years and 74.2% after 5 years.…”

“…Only 2 patients (7.7%) needed surgery during this period of follow up. These results were achieved with repeat EBD in 42% of patients; thus, the cumulative redilation-free rate was 47.8% and 31.9% at 2 and 3 years post initial EBD, respectively [ 149 ]. Lastly, a multi-center retrospective study included 305 patients, 100 of whom underwent successful EBD facilitated by BAE.…”