• Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn’s disease strictures

    Journal of Crohn’s and Colitis 2014 8 392-400

     

    Some patients with Crohn’s disease develop strictures in the bowel. Strictures are parts of the bowel that have become narrowed; they can lead to complete or partial blockage of the bowel. Strictures may occur as a consequence of the disease itself (primary) or after surgery where two bits of bowel are joined together (anastomotic).  In the past an operation was the only treatment for strictures but now they can be managed by blowing up a balloon inside them (and removing it) at endoscopy (endoscopic dilation). However the complications and long term outcomes of this approach are not clear, particularly for primary strictures. This study reviewed the notes of 128 adult patients seen at the Cleveland Clinic in the USA between 1998 and 2010. Of the 169 strictures 52% were primary and 48% anastomotic. There were no significant differences in outcomes between the two types. Overall only 28% needed one treatment, approximately 60% needed repeat endoscopy and 72% had repeat endoscopy and/or surgery. In total about 30% of strictures needed surgery. Having infliximab or drugs such as azathioprine did not reduce the need for further intervention. The average time from first dilation to needing a second procedure was around 18 months. In 77 strictures it was not possible to get the endoscopy through the narrowed area at all but after balloon dilatation it was possible to get the endoscope through the stricture in 83%. Only 4 (0.02%) procedures had immediate complications (bleeding or making a hole in the bowel wall) all of these had had steroids injected into the stricture before dilatation.

    Overall this study showed that balloon dilatation is safe for primary and anastomotic strictures but that patients may need more than one procedure. However this study doesn’t tell us how well the patients were between repeat procedures.