Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 382-390
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.382
Endoscopic balloon dilation for management of stricturing Crohn’s disease in children
Brianna McSorley, Robert A Cina, Candi Jump, Johanna Palmadottir, J Antonio Quiros
Brianna McSorley, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
Robert A Cina, Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
Candi Jump, Department of Pediatric Gastroenterology, Medical University of South Carolina, Charleston, SC 29425, United States
Johanna Palmadottir, Department of Pediatric Gastroenterology, MUSC Children's Hospital, Charleston, SC 29425, United States
J Antonio Quiros, Department of Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, New York, NY 10029, United States
Author contributions: McSorley B and Quiros JA collaborated in initial study design and performed all the data acquisition, data analysis, drafting of the manuscript and approval of the final submission; Cina RA, Jump C and Palmadottir J supported initial study conception, data interpretation and approval of final submission.
Institutional review board statement: Study was approved by the Institutional Review Board at the Medical University of South Carolina, IRB# Pro00081854.
Informed consent statement: The need for informed consent was waived by the Institutional Review Board at the Medical University of South Carolina due to the study being a retrospective chart review and causing no more than minimal risk to the patients.
Conflict-of-interest statement: The authors report no existing conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: J Antonio Quiros, MD, PhD, Professor, Department of Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, One Gustave Levy Place, New York, NY 10029, United States. jose.quiros@mssm.edu
Received: March 24, 2021
Peer-review started: March 24, 2021
First decision: June 3, 2021
Revised: June 15, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: September 16, 2021
Abstract
BACKGROUND

Crohn’s disease (CD) has a multitude of complications including intestinal strictures from fibrostenotic disease. Fibrostenotic disease has been reported in 10%-17% of children at presentation and leads to surgery in 20%-50% of cases within ten years of diagnosis. When symptoms develop from these strictures, the treatment in children has primarily been surgical resection. Endoscopic balloon dilation (EBD) has been shown to be a safe and efficacious alternative to surgery in adults, but evidence is poor in the literature regarding its safety and efficacy in children.

AIM

To evaluate the outcomes of children with fibrostenosing CD who underwent EBD vs surgery as a treatment.

METHODS

In a single-center retrospective study, we looked at pediatric patients (ages 0-18) who carry the diagnosis of CD, who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1, 2012 through May 1, 2019. We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype. The type of intervention for patients’ strictures was then identified through procedural and surgical billing codes. We evaluated their demographics, clinical variables, whether they underwent EBD vs surgery or both, and their clinical outcomes.

RESULTS

Of the 139 patients with CD, 25 (18%) developed strictures. The initial intervention for a stricture was surgical resection in 12 patients (48%) and EBD in 13 patients (52%). However, 4 (33%) patients whom initially had surgical resection required follow up EBD, and thus 17 total patients (68%) underwent EBD at some point in their treatment process. For those 8 patients who underwent successful surgical resection alone, 4 of these patients (50%) had a fistula present near the stricture site and 4 (50%) had strictures greater than 5 cm in length. All patients who underwent EBD had no procedural complications, such as a perforation. Twenty-two (88%) of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period.

CONCLUSION

EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.

Keywords: Crohn’s disease, Intestinal strictures, Endoscopic dilation, Pediatrics, Endoscopic balloon dilation

Core Tip: Endoscopic balloon dilation (EBD) has been shown to be a safe and efficacious alternative to surgery in adults, but evidence is poor in the literature regarding its safety and efficacy in children. In our retrospective cohort, 22 of the 25 (88%) treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period. All patients who underwent EBD had no procedural complications, such as a perforation, showing that EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with Crohn’s disease.