Systematic review: endoscopic dilatation in Crohn’s disease

Hassan, Cesare; Zullo, Angelo; Francesco, De; Ierardi, Enzo; Giustini, Marco; Pitidis, Alessio; Taggi, Franco; Winn, Simon; Morini, Sergio

doi:10.1111/j.1365-2036.2007.03532.x

Cited by 262 publications

(235 citation statements)

References 33 publications

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“…Endoscopy can also serve a therapeutic role in the dilation of strictures, particularly those at a surgical anastomosis, although double-blind, sham-controlled trials are lacking (50,51) . A recent systematic review suggested that those patients who bene t most from endoscopic balloon dilation have short (less than 4 cm) postsurgical anastomotic strictures (52) . e use of adjunctive corticosteroid injection into strictures at the time of balloon dilation was not e ective (53) .…”

Section: Generalmentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Section: Generalmentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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“…Perforation rates in benign gastric outlet obstruction are high as 7.4%, risk factors are dilation in the setting of active ulceration and balloon size greater than 15 mm [42]. In lower gastrointestinal strictures' dilation, mostly in anastomosis and in Crohn's disease, the perforation is more often reported with 25 mm balloons [43,44].…”

Section: Dilationmentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.

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“…On the other hand, recurrent symptoms frequently make it necessary to repeat the procedure. In detail, 59% of patients avoided surgery and repeat endoscopy until the end of follow-up, 22% required two sessions, while the remaining 19% required more than two dilatations [8]. This is probably due to the fact that symptomatic CD strictures are not purely fibrotic, but are muscular as well, which might explain the tendency to be resistant to dilatation.…”

Section: Safety and Efficacymentioning

confidence: 99%

“…In the only systematic review available, a multivariate statistical analysis was performed on a simulated population from the available studies up to 2007 [8]. The study found that mostly postsurgical strictures were dilated with a technical success rate of 86%, and long-term efficacy was achieved in 58% of patients, with a mean multivariate analysis in the earlier mentioned systematic review, a stricture length of ≤4 cm was associated with a surgery-free outcome, and this was the only predictor that showed statistical significance: naïve vs. postsurgical strictures, active vs. inactive disease, and sedation vs. anesthesia; possibility to pass the scope after dilatation or balloon caliber (above/below 20 mm) showed no influence on the technical success or the efficacy after dilatation [8]. EBD can be painful; therefore, sedation with a mixture of benzodiazepine and pethidin is recommended by most authors.…”

Section: Safety and Efficacymentioning

confidence: 99%

Endoscopic solutions for stricturing Crohn's disease

Szmola

Rácz

Tulassay

et al. 2012

IMAS

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Abstract:Intestinal stenosis is a frequent and oftentimes recurring problem in patients with Crohn's disease, accompanied by a high-risk for bowel resection and subsequent short bowel syndrome. Medical therapy has not proven successful, and even the most conservative surgical options are hampered by a definite mortality rate (and high recurrence rates) without doubt. Technical improvements in endoscopic devices over recent years have created an operative subspecialty (therapeutic endoscopy) that can be applied to several gastrointestinal diseases. Endoscopic balloon dilatation (EBD) for Crohn's disease has been developed to prevent or delay the need for surgical resection. The endoscopy-assisted dilatation is a safe and effective treatment modality for uncomplicated, short Crohn's strictures, and therefore should be offered to Crohn's disease patients. Here, we briefly review the current knowledge on hydrostatic balloon dilatation and present a relevant case from our clinical practice.

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Systematic review: endoscopic dilatation in Crohn’s disease

Abstract: SUMMARY BackgroundEndoscopic dilatation for Crohn's disease has been evaluated only in some small and heterogeneous studies.

Cited by 262 publications

References 33 publications

Management of Crohn's Disease in Adults

Management of Crohn's Disease in Adults

Emergencies after endoscopic procedures

Endoscopic solutions for stricturing Crohn's disease

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