Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease - PubMed (original) (raw)
Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease
A Gustavsson et al. Aliment Pharmacol Ther. 2012 Jul.
Abstract
Background: Bowel strictures are a major cause of morbidity, hospitalisation and surgery in Crohn's disease.
Aim: We report short- and long-term efficacy and safety of endoscopic balloon dilation of strictures due to Crohn's disease.
Methods: Retrospective study of patients who underwent endoscopic balloon dilation between 1987 and 2009.
Results: We performed 776 dilations, of which 621 (80%) were on anastomotic strictures, in 178 patients (94 women) with Crohn's disease. At first dilation, median (IQR) age of patients was 45 (37-56) years and disease duration 16 (8-22) years. Technical success rate was 689/776 (89%). A subset of 75 patients from the primary catchment area, with >5-year follow-up, underwent a total of 246 dilations. At 1-year follow-up, 60/75 (80%) patients had undergone no further intervention or one additional dilation only. At 3 and 5 years, corresponding figures were 43/75 (57%) and 39/75 (52%). Cumulative proportions of patients undergoing surgery at 1, 3 and 5 years were 13%, 28% and 36%. Complication rate per procedure for all 178 patients was 41/776 (5.3%), bowel perforation (n = 11, 1.4%), major bleeding requiring blood transfusion (n = 8, 1.0%), minor bleeding (n = 10, 1.3%) and abdominal pain or fever (n = 12, 1.5%). Ten patients underwent surgery due to complications (perforation n = 8, bleeding n = 2). There was no procedure-related mortality.
Conclusions: Endoscopic balloon dilation is an efficacious and safe alternative to surgical resection of intestinal strictures in Crohn's disease. At 5-year follow-up, 52% of patients required no further or one additional dilation only, whereas 36% had undergone surgical resection. Complication frequency was low.
© 2012 Blackwell Publishing Ltd.
Comment in
- Letter: endoscopic balloon dilatation or strictureplasty for stricturing Crohn's disease?
Yamamoto T, Shiraki M. Yamamoto T, et al. Aliment Pharmacol Ther. 2012 Aug;36(4):403; author reply 404. doi: 10.1111/j.1365-2036.2012.05187.x. Aliment Pharmacol Ther. 2012. PMID: 22803650 No abstract available. - Commentary: endoscopic dilatation for stricturing Crohn's disease.
Louis E, Gast P, Van Kemseke C, Reenaers C. Louis E, et al. Aliment Pharmacol Ther. 2012 Sep;36(5):494-6. doi: 10.1111/j.1365-2036.2012.05209.x. Aliment Pharmacol Ther. 2012. PMID: 22860612 No abstract available.
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