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. 2024 Aug 4;6(3):otae041.
doi: 10.1093/crocol/otae041. eCollection 2024 Jul.

Patient-Related Factors Associated With Long-Term Outcomes After Successful Endoscopic Balloon Dilation For Crohn's Disease-Associated Ileo-Colic Strictures: A Systematic Review and Meta-analysis

Hiram Menezes Nascimento Filho  1 , Angelo So Taa Kum  1 , Alexandre Moraes Bestetti  1 , Pedro Henrique Veras Ayres da Silva  1 , Megui Marilia Mansilla Gallegos  1 , Adérson Omar Mourão Cintra Damião  2 , Udayakumar Navaneethan  3 , Eduardo Guimarães Hourneaux de Moura  1
Affiliations

Patient-Related Factors Associated With Long-Term Outcomes After Successful Endoscopic Balloon Dilation For Crohn's Disease-Associated Ileo-Colic Strictures: A Systematic Review and Meta-analysis

Hiram Menezes Nascimento Filho et al. Crohns Colitis 360. .

Abstract

Background: Successful Crohn's disease (CD) therapy relies on timely and precise management strategies. Endoscopic balloon dilation (EBD) has been applied as a first-line treatment for symptomatic CD-associated strictures due to its minimally invasive nature and the possibility of preserving intestinal length.

Objective: The aim of the present study was to determine patient-related predictive factors associated with the need for surgery for CD-associated ileocolic strictures after technically successful EBD.

Methods: All original studies published before December 2023 that reported the outcomes of patients treated with EBD for ileocolic strictures secondary to CD and described follow-up for at least 1 year were included. The difference in risk of needing surgery was calculated for 8 different patient characteristics (Sex, smoking habit, previous surgery, biologic therapy, steroids, immunosuppressors, nature of the stricture, and endoscopic disease activity).

Results: There were significant differences in the risk of needing surgery after EBD among patients who underwent surgery and patients without a history of surgery (RD: -0.20 [-0.31, -0.08]), patients with endoscopic mucosal activity and patients in remission at the time of EBD (RD: 0.19 [0.04, 0.34]), patients using biologics at the time of EBD and patients not using biologics (RD: -0.09 [-0.16, -0.03]), and patients using steroids and those not using steroids at the time of EBD (RD: 0.16 [0.07, 0.26]).

Conclusions: The use of biologics and endoscopic disease remission at the time of EBD were protective factors against the need for surgery. No previous surgery or use of steroids at the time of EBD was associated with the need for surgery during follow-up.

Keywords: Crohn’s disease; endoscopic balloon dilation; strictures.

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Conflict of interest statement

None declared. Competing interests: The authors declare that they have no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
PRISMA flow chart.
Figure 2.
Figure 2.
Quality in Prognosis Studies (QUIPS) tool for risk of bias assessment.
Figure 3.
Figure 3.
Effect of gender on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 4.
Figure 4.
Effect of smoking habit on the need for surgery after EBD. M-H: Mantel-Haenszel; CI, confidence interval.
Figure 5.
Figure 5.
Effect of previous CD-related surgery on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 6.
Figure 6.
Effect of biologic treatment on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 7.
Figure 7.
Effect of steroids on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 8.
Figure 8.
Effect of immunosuppressants on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 9.
Figure 9.
Effect of the nature of the stricture on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 10.
Figure 10.
Effect of endoscopic disease activity on the need for surgery after EBD. M-H, Mantel-Haenszel; CI, confidence interval.
See this image and copyright information in PMC

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