Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures

Morar, Pritesh; Faiz, Omar; Warusavitarne, J; Brown, S. R.; Cohen, Richard; Hind, Daniel; Abercrombie, J F; Ragunath, Krish; Sanders, David S.; Arnott, Ian; Wilson, Graham M.; Bloom, Stuart; Arebi, Naila

doi:10.1111/apt.13388

Cited by 107 publications

(83 citation statements)

References 43 publications

(434 reference statements)

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“…Using stepwise logistic regression in a systematic review, Hassan et al36 pointed out that stricture length of 4 cm or more was the only significant risk factor for recurrence (OR, 4.01; 95% CI, 1.16–13.8; P <0.028). On the other hand, other factors, such as the nature of strictures (naïve vs. postsurgical, active CD vs. inactive CD lesion), scope passage after EBD, and the method of graded dilation were not associated with treatment outcome 3536. Smoking is thought to be a risk factor for surgery after EBD 37.…”

Section: Ebd For Colorectal and Ileo-colonic Anastomotic Stricturesmentioning

confidence: 94%

“…In patients with recurrence of symptoms, redilation or surgical intervention should be performed. According to a meta-analysis that summarized 25 studies, including 1,089 patients and 2,664 dilations, the proportion of patients who required further dilation at 1, 2, and 5 years of follow-up was 31.6%, 25.9%, and 1.7%, respectively 35. Overall, the cumulative proportion of patients requiring further dilation over 5 years was 80.6%.…”

Section: Ebd For Colorectal and Ileo-colonic Anastomotic Stricturesmentioning

confidence: 99%

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Current status of endoscopic balloon dilation for Crohn's disease

Hirai

2017

Intest Res

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The therapeutic target in Crohn's disease (CD) has been raised to the achievement of mucosal healing. Although effective treatments that target cytokines and other molecules has been widely used for CD, intestinal strictures are still a major cause of surgery. Endoscopic balloon dilation (EBD) is known to be an effective and safe intervention for intestinal strictures in CD. Since frequent intestinal resection often results in short bowel syndrome and can decrease the quality of life, EBD can help avoid surgery. EBD with a conventional colonoscope for Crohn's strictures of the colon and ileo-colonic anastomosis has established efficacy and safety. In addition, EBD using balloon-assisted enteroscopy has recently been applied for small bowel Crohn's strictures. Although the evidence is not strong, EBD may become an alternative to surgery in small bowel strictures in CD. EBD and other new methods such as self-expanding stent implantation for Crohn's strictures may be useful and safe; however, it is important to address several issues regarding these interventions and to establish a protocol for combined therapies.

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Section: Ebd For Colorectal and Ileo-colonic Anastomotic Stricturesmentioning

confidence: 94%

Section: Ebd For Colorectal and Ileo-colonic Anastomotic Stricturesmentioning

confidence: 99%

Current status of endoscopic balloon dilation for Crohn's disease

Hirai

2017

Intest Res

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“…This increased risk of perforation with stricture dilation in CD[106] must be weighed against the therapeutic benefits achieved. Efforts need to focus on risk stratification of small bowel strictures to determine which patients may be more suitable for small bowel resection as compared to endoscopic dilation.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: Safety of balloon assisted enteroscopy in Crohn’s disease

Arulanandan¹,

Dulai²,

Singh³

et al. 2016

WJG

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AIMTo determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy (BAE) in Crohn’s disease (CD).METHODSSystematic review (PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy (DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease activity.RESULTSPer procedure perforation rate of diagnostic BAE in CD was 0.15% (95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications (0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12% (95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications (0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74% (95%CI: 0.85-3.55). Eighty-six percent of therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients.CONCLUSIONDiagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

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“…Previous reports have shown that the short-term success rate is over 80% [15, 16]. In the recent report of the long-term efficacy of EBD, double-balloon endoscopy (DBE)-assisted EBD for Crohn’s small intestinal stricture provides a favorable outcome [17].…”

Section: Introductionmentioning

confidence: 99%

“…In the recent report of the long-term efficacy of EBD, double-balloon endoscopy (DBE)-assisted EBD for Crohn’s small intestinal stricture provides a favorable outcome [17]. However, there are a few studies about the long-term efficacy of EBD and no detailed standard of suitable strictures are available to postpone the need for surgery [16, 18]. In light of all this information, further evidence supporting the long-term efficacy of EBD may be needed.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures

Abstract: SUMMARY BackgroundEndoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies.

Cited by 107 publications

References 43 publications

Current status of endoscopic balloon dilation for Crohn's disease

Current status of endoscopic balloon dilation for Crohn's disease

Systematic review: Safety of balloon assisted enteroscopy in Crohn’s disease

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

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