Efficacy and Safety of Endoscopic Balloon Dilation for Upper Gastrointestinal Strictures of Crohn's Disease

Abstract

Background: Few articles focused on endoscopic balloon dilation (EBD) in the management of Crohn's strictures in the upper gastrointestinal (GI) tract.

Aims: The purpose of this study was to evaluate the long-term efficacy and safety of EBD for Crohn's strictures in the upper GI tract and to determine early predictors of response and surgical intervention.

Methods: All eligible patients who underwent EBD for Crohn's strictures in the upper GI tract were retrospectively reviewed. The long-term success was defined as the recovery of normal diets without surgical intervention over the follow-up period. In order to seek early predictors, patients who achieved long-term success were compared with those who didn't.

Results: A total of 67 dilations of upper GI strictures were performed between June 2011 and March 2015 on 24 patients (mean age 25.6 ± 6.7, 20 male) with Crohn's disease. Technical success was achieved in 62 of 67 dilations (92.5 %) with a complication rate of 3 %. After the median follow-up period of 23.0 months (range 6.2-51.2 months), nine patients underwent surgical intervention, nine patients were still depending on tube feeding; in the meantime, only six (25 %) patients achieved long-term success. Additionally, patients who remained 1 month intervention-free (55.6 vs. 5.9 %, P = 0.015) were more likely to achieve long-term success.

Conclusions: EBD was a safe procedure, but not a potent therapy for Crohn's upper GI strictures. Meanwhile, 1-month response could serve as an early predictor of the long-term response.

Keywords: Crohn’s disease; Early predictors; Endoscopic balloon dilation; Upper gastrointestinal strictures.