The response of Crohn’s strictures to endoscopic balloon dilation

Mueller, Tobias; Rieder, B.; Bechtner, G.; Pfeiffer, A.

doi:10.1111/j.1365-2036.2009.04225.x

Cited by 82 publications

(79 citation statements)

References 27 publications

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“…This is in keeping with previous studies on DBE dilatation of small bowel strictures. Furthermore, our experience is similar to other published work with regards to the need for multiple treatments particularly in CD [Mueller et al 2010;Thienpont et al 2010]. In a Dutch study 74% required repeat dilatation [Karstensen et al 2012].…”

Section: Discussionsupporting

confidence: 78%

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience

Gill¹,

Kaffes²

2013

Therap Adv Gastroenterol

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Background: There is little data on the role of balloon enteroscopy and small bowel strictures. We aim to characterize the diagnostic role of double balloon enteroscopy (DBE) in small bowel strictures and document the outcomes of dilatation. Methods: This is a retrospective review from a single tertiary referral centre DBE database from July 2004 to September 2012. All patients with suspected strictures in the small bowel undergoing DBE were included. The position of the small bowel strictures considered for dilatation was determined by diagnostic imaging, i.e. CT enterography, MR enterography or capsule endoscopy in the workup before DBE. Endpoints included stricture description, dilatation parameters and response to treatment. Main outcome measurements were the safety and efficacy of DBE and dilatation. Results: From our DBE database of 594 patients, a total of 32 patients underwent 44 DBE procedures for suspected or known strictures. Stricture aetiology included Crohn's disease (CD), nonsteroidal anti-inflammatory drugs (NSAIDs), surgical, Beçhets disease and one unknown. A total of 17 patients did not undergo dilatation as the strictures were ulcerated, nonobstructing or of uncertain aetiology. From the total of 25 dilatations in 15 patients that were attempted, 8/15 (53%) patients had 1 dilatation, 5 patients had 2 dilatations, 1 had 3 dilatations and 1 had 4 dilatations. The mean dilatation diameter was 14 mm. Three patients underwent surgery post-dilatation (2 for perforation). Mean follow up was 16 months. Conclusion: DBE is a useful method in determining the need for dilatation by assessing for active ulceration. Dilatation is effective in the 10-18 mm range, however perforation does occur.

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Section: Discussionsupporting

confidence: 78%

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience

Gill¹,

Kaffes²

2013

Therap Adv Gastroenterol

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“…In this study, patients without stenotic symptoms were included as subjects, and the maximum observation period after EBD was only 3 years. Therefore, the cumulative surgery-free rate was approximately 70% at 3 years, similar to the results of previous studies (17)(18)(19)(20)(21)(22)(23)(24)(25)32). The cumulative rate of surgery in CD reportedly ranges from 46% to 62% at 5 years and from 61% to 75% at 10 years.…”

Section: Discussionsupporting

confidence: 78%

“…The incidence of perforation is reportedly 0-9%, and this complication accounts for 5-25% of all cases with serious complications (17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)33). In this study, portal emphysema developed in one patient (34); this complication was apparently attributable to the excessive CO 2 gas insufflation at the time of scope insertion, in addition to a pre-existing tendency for intestinal gas retention.…”

Section: Discussionmentioning

confidence: 99%

“…EBD is an alternative to surgery in CD cases with intestinal stenosis. The use of EBD for the stenotic lesions of CD has been reported since the 1990s, with the procedure being conducted using an upper gastrointestinal endoscope or colonoscope mainly for the stenosis in the upper gastrointestinal tract, in the large intestine, or at the anastomotic site (17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…Advancements in endoscopic techniques and drug therapy, especially biological products, have enabled endoscopic dilation to be applied for intestinal stenosis in patients with CD, followed by enhanced medical treatments and the postponement or even avoidance of surgery (17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

Kanamori

Sugaya²,

Tominaga³

et al. 2017

Turk J Gastroenterol

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Background/Aims: Endoscopic balloon dilation (EBD) can serve as an alternative to surgery for intestinal stenosis associated with Crohn's disease (CD). However, there has been controversy regarding the efficacy and safety of EBD. Here we sought to determine the therapeutic efficacy and safety of EBD for intestinal stenosis in CD. Materials and Methods: Of 43 patients with CD accompanied by intestinal stenosis, 30 underwent EBD. These 30 patients were examined retrospectively in terms of the scope passage rate, surgery-free rate, and whether or not the observation of the distal intestinal tract influenced the therapeutic strategy. Results: The overall scope passage and surgery-free rates were 90.0% and 76.7%, respectively. There were no statistically significant differences in the site of the dilated intestinal tract among groups. Patients who had inflammation in the distal intestinal tract alone after EBD accounted for 56.7%. The rate of re-dilation was 46.7%, and time until re-dilation was 6.6±3.6 months. Conclusion: EBD was associated with favorable short-term and long-term outcomes and good safety. Observation of the distal intestinal tract influenced the decision-making process for therapeutic strategies. The results of this study suggest that EBD may allow the postponement or even avoidance of surgery, enabling not only intestinal dilation but also the evaluation of mucosal healing to be performed. Thus, EBD is considered to be an effective alternative treatment for intestinal stenotic lesions in patients with CD.

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A comparison of endoscopic and surgical treatment of strictures in patients with Crohn’s disease

Dubcenco

MacDonald

Feagan

2013

Cochrane Database of Systematic Reviews

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The response of Crohn’s strictures to endoscopic balloon dilation

Abstract: SUMMARY BackgroundEndoscopic balloon dilation has been shown to be an alternative to surgery in the treatment of Crohn's symptomatic strictures.

Cited by 82 publications

References 27 publications

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience

Endoscopic balloon dilation for stenotic lesions in Crohn’s disease

A comparison of endoscopic and surgical treatment of strictures in patients with Crohn’s disease

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