Systematic review with meta‐analysis: efficacy of balloon‐assisted enteroscopy for dilation of small bowel Crohn's disease strictures

Abstract

SummaryBackgroundEvidence for endoscopic balloon dilation of small intestinal strictures in Crohn's disease (CD) using balloon‐assisted enteroscopy is scarce.AimTo evaluate endoscopic balloon dilation for the treatment of small intestinal CD strictures using balloon‐assisted enteroscopy.MethodsCitations in Embase, MEDLINE, and Cochrane were systematically reviewed. In a meta‐analysis of 18 studies with 463 patients and 1189 endoscopic balloon dilations, technical success was defined as the ability to dilate a stricture. Individual data were also obtained on 218 patients to identify outcome‐relevant risk factors.ResultsIn the pooled per‐study analysis, technical success rate of endoscopic balloon dilation was 94.9%, resulting in short‐term clinical efficacy in 82.3% of patients. Major complications occurred in 5.3% of patients. During follow‐up, 48.3% of patients reported symptom recurrence, 38.8% were re‐dilated and 27.4% proceeded to surgery. On the per‐patient‐based multivariable analysis, that patients with disease activity in the small intestine had lower short‐term clinical efficacy (odds ratio 0.32; 95% confidence interval 0.14‐0.73, P = 0.007). Patients with concomitant active disease in the small and/or large intestine had an increased risk to proceed toward surgery (hazard ratio 1.85; 95% confidence interval 1.09‐3.13, P = 0.02 and hazard ratio 1.77; 95% confidence interval 1.34‐2.34, P < 0.001).ConclusionsBalloon‐assisted enteroscopy for dilatation of CD‐associated small intestinal strictures has high short‐term technical and clinical efficacy and low complication rates. However, up to two‐thirds of patients need re‐dilation or surgery.

Intestinal stricture in Crohn's disease: A 2020 update

“…However, EBD has a poor therapeutic effect on patients with CD and prestenotic luminal dilatation, which often indicates a long‐term disease or high‐grade stenosis 81,83‐85 . In 2020, several retrospective studies indicated that EBD using balloon‐assisted enteroscopy could delay the recurrence and reduce surgical intervention in patients with CD and small bowel stricture, with a short‐term clinical efficacy of 82.3% and long‐term effective rate of 76.5%, as well as a low complication rate of 5.3% 86‐88 …”

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

“…Numerous reports have documented the efficacy and safety of EBD in carefully selected cases [ 19 , 139 - 142 ]. EBD can improve symptoms and delay or obviate recourse to surgery [ 108 ].…”

“…Technical success was achieved in 90% and symptomatic relief was achieved in 80%; the complication rate was 2.8%. Nevertheless, almost 75% of the patients needed repeat dilation and 43% required surgery within 24 months [ 142 ]. A systematic review of SB dilation facilitated by DBE reported an 80% long-term success rate, with a complication rate of 2.6% per dilation and 4.8% per patient.…”

Is Paradigm for the Role of Balloon-Assisted Enteroscopy Changing in Crohn’s Disease?

“…Up to 75% of patients with CD ultimately undergo surgery at least once during their lifetime, and the main cause is strictures. 10 Stricture dilatation with BAE has been shown to have a high technical success rate (94.9%) and a low rate of major complications (5.3%). 10 Consistent with the result of previous reports, the study by Jeon et al 9 also showed a high technical success rate of over 80%.…”

“… 10 Stricture dilatation with BAE has been shown to have a high technical success rate (94.9%) and a low rate of major complications (5.3%). 10 Consistent with the result of previous reports, the study by Jeon et al 9 also showed a high technical success rate of over 80%. 9 One of the most notable findings of this study is that the use of BAE related to small bowel strictures was significantly increased in the second period compared to that in the first period (2.9% vs 21.3%, p=0.002).…”