Prognostic factors, effectiveness and safety of endoscopic balloon dilatation for de novo and anastomotic strictures in Crohn’s disease—A multicenter “real life” study

Abstract

Introduction: Crohn’s disease (CD) is a chronic inflammatory disease which is frequently complicated by obstructive symptoms secondary to development of intestinal strictures. The aim of this “real life” study was to assess the effectiveness, safety and outcome of endoscopic balloon dilatation (EBD) in de novo vs. anastomotic stenoses. Patients and methods: Data of 93 EBDs in 46 CD patients were retrospectively analyzed. Technical success rate was defined as the ability of endoscope to traverse the stenosis after dilatation. Long-term clinical success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilatation following the technical success. Results: About 62.4% of strictures were de novo and 37.6% anastomotic. The elapsed time between diagnosis and the first balloon dilatation was 9.5 (0–35) years. About 73.1% of dilatations were successful over a short-term period without serious complications. About 47.8% of patients showed that EBD is effective over a long-term period. EBD of anastomotic strictures showed better outcome than that of de novo strictures, however biological therapy before or after dilatation, immunomodulatory therapy and the time between the diagnosis and the first dilatation had no influence on long-term effectiveness. Nine subjects required surgery due to strictures after balloon dilatation. Conclusion: The results of this study highlight that EBD is an effective therapy of short strictures in CD with low complication rate. Using this endoscopic method we can avoid surgical interventions in most of the cases. EBD of anastomotic stenosis may be more preferable than that of the de novo strictures.

Keywords

• crohn’s disease
• balloon dilatation
• stricture
• endoscopy