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Endoscopic balloon dilatation of intestinal strictures in Crohn's disease: Safe alternative to surgery
Author(s) -
Ajlouni Yousef,
Iser John H,
Gibson Peter R
Publication year - 2007
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2006.04764.x
Subject(s) - medicine , perforation , surgery , balloon dilatation , fistula , crohn's disease , anastomosis , complication , endoscope , balloon , abscess , endoscopy , disease , materials science , punching , metallurgy
Background and Aim: Endoscopic balloon dilatation (EBD), a non‐surgical treatment option for intestinal strictures in Crohn's disease, appears to be applied infrequently, possibly due to the perceived risk of perforation and early recurrence. This study aimed to determine the outcomes of EBD by a single endoscopist using a defined technique. Methods: The records of all patients with Crohn's disease in whom EBD was attempted over a 12‐year period were examined to determine the rate of technical success, complications and outcome. A stricture was defined as that which prevented passage of the 14 mm diameter colonoscope. Technical success was defined as the ability to traverse the stricture postdilatation. Patients were selected on the colonoscopic appearance of the stricture and dilatation was performed using through‐the‐endoscope balloons. Antibiotics were given during and for 7 days postdilatation. Results: EBD was attempted on 83 strictures (31 anastomotic and 52 primary) in 37 patients (15 males) and was successful in 75 (90%) of 31 patients. A single dilatation only was required in 21 patients who had a median follow‐up of 20 months (range 6–122 months). Recurrent symptomatic stricture requiring dilatation (eight patients) or surgery (two patients) occurred 8 (1–112) months after the initial dilatation. The only complication occurred in one patient where an intra‐abdominal fistula and abscess were probably related to the dilatation. Conclusion: EBD of intestinal strictures associated with Crohn's disease has a low complication rate and leads to prolonged clinical benefit. It should be considered as a real alternative to surgery.