Endoscopic dilation of small-intestine strictures in Crohn's disease by balloon-assisted enteroscopy: a systematic review and meta-analysis

Abstract

Background: Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD.

Methods: We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using I ² statistics.

Results: We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; I ²=53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; I ²=71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; I ²=57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; I ²=28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; I ²=3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; I ²=59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; I ²=85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; I ²=44%].

Conclusion: BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery.

Keywords: Crohn’s disease; balloon-assisted enteroscopy; endoscopic dilation; stricture.

Figure 1

Forest plot, technical success of balloon-assisted endoscopy CI, confidence interval

Figure 2

Forest plot, clinical success of balloon-assisted endoscopy CI, confidence interval