Endoscopic balloon dilatation for Crohn's strictures of the gastrointestinal tract is feasible

Abstract

Introduction: Despite optimized medical treatment, Crohn´s disease can cause gastrointestinal (GI) strictures, which requires surgical intervention. Lately, endoscopic balloon dilatation has been established as an alternative to surgery. In the following, we report our experiences with endoscopic dilatation of strictures in the gastrointestinal tract caused by Crohn´s disease.

Material and methods: From January 2005 to February 2011, 23 patients with Crohn´s disease were referred for endoscopic dilatation. Based on data derived from this cohort, a retrospective analysis was made. Patients with Crohn´s disease, obstructive GI symptoms and known bowel strictures were included. Their mean age was 39 years (20-59 years) and 65% were female. Prior to the procedure, all patients had been evaluated by barium small-bowel follow through, abdominal magnetic resonance imaging and/or endoscopy.

Results: Dilatation was performed in 19/23 (83%) patients. During a mean follow-up period of 21 months (range 1-47 months), relapse was observed in 14/19 patients (74%). Five patients (26%) were referred to surgery due to complications (n = 1) or multiple relapses (n = 4). A total of 54 endoscopic dilatations were performed during the study period. Only one complication (perforation) was experienced, which resulted in a complication rate of 1.9%.

Conclusion: Endoscopic dilatation in patients with Crohn´s disease with obstructive GI symptoms seems safe. In three out of four patients, surgery was avoided during a mean follow-up of two years. Further optimisation of the procedure is needed to lower the rate of recurrence.