Brief Article
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World J Gastroenterol. May 7, 2013; 19(17): 2660-2667
Published online May 7, 2013. doi: 10.3748/wjg.v19.i17.2660
Short- and long-term efficacy of endoscopic balloon dilation in Crohn’s disease strictures
Nicola de’Angelis, Maria Clotilde Carra, Osvaldo Borrelli, Barbara Bizzarri, Francesca Vincenzi, Fabiola Fornaroli, Giuseppina De Caro, Gian Luigi de’Angelis
Nicola de’Angelis, Department of Digestive Surgery, Hopital Henri Mondor-Université Paris Est, 94010 Creteil, France
Maria Clotilde Carra, Barbara Bizzarri, Francesca Vincenzi, Fabiola Fornaroli, Giuseppina De Caro, Gian Luigi de’Angelis, Gastroenterology and Operative Endoscopy Unit, University of Parma, 43121 Parma, Italy
Osvaldo Borrelli, Department of Gastroenterology, Great Ormond Street Hospital and UCL, London WC1N 3JH, United Kingdom
Author contributions: de’Angelis N contributed to the study design, data analysis, data collection, data interpretation, manuscript revision, and the final approval of the submitted version; Carra MC contributed to data analysis, data interpretation, manuscript drafting, manuscript revision, and final approval of the submitted version; Borrelli O contributed to study design, data interpretation, manuscript revision, and final approval of the submitted version; Bizzarri B, Vincenzi F, De Caro G and Fornaroli F coordinated and provided data collection; de’Angelis GL contributed to the study design and data interpretation, and he also performed the clinical procedures and gave his final approval of the submitted version; all authors gave their approval to the present manuscript for publication.
Correspondence to: Dr. Nicola de’Angelis, Department of Digestive Surgery, Hopital Henri Mondor-Université Paris Est, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. nic.deangelis@yahoo.it
Telephone: +33-1-49812348 Fax: +33-1-49812432
Received: October 30, 2012
Revised: December 31, 2012
Accepted: January 18, 2013
Published online: May 7, 2013
Abstract

AIM: To evaluate short- and long-term efficacy of endoscopic balloon dilation in a cohort of consecutive patients with symptomatic Crohn’s disease (CD)-related strictures.

METHODS: Twenty-six CD patients (11 men; median age 36.8 year, range 11-65 years) with 27 symptomatic strictures underwent endoscopic balloon dilation (EBD). Both naive and post-operative strictures, of any length and diameter, with or without associated fistula were included. After a clinical and radiological assessment, EBD was performed with a Microvasive Rigiflex through the scope balloon system. The procedure was considered successful if no symptom reoccurred in the following 6 mo. The long-term clinical outcome was to avoid surgery.

RESULTS: The mean follow-up time was 40.7 ± 5.7 mo (range 10-94 mo). In this period, forty-six EBD were performed with a technical success of 100%. No procedure-related complication was reported. Surgery was avoided in 92.6% of the patients during the entire follow-up. Two patients, both presenting ileocecal strictures associated with fistula, failed to respond to the treatment and underwent surgical strictures resection. Of the 24 patients who did not undergo surgery, 11 patients received 1 EBD, and 13 required further dilations over time for the treatment of relapsing strictures (7 patients underwent 2 dilations, 5 patients 3 dilations, and 1 patient 4 dilations). Overall, the EBD success rate after the first dilation was 81.5%. No difference was observed between the EBD success rate for naive (n = 12) and post-operative (n = 15) CD related strictures (P > 0.05).

CONCLUSION: EBD appears to be a safe and effective procedure in the therapeutic management of CD-related strictures of any origin and dimension in order to prevent surgery.

Keywords: Endoscopic balloon dilation, Crohn’s disease, Strictures, Endoscopy, Gastrointestinal surgery