Safety and efficacy of endoscopic balloon dilation for treatment of Crohn's disease strictures

Background and Study Aims: Strictures are a substantial cause of morbidity in patients with Crohn's disease. Endoscopic balloon dilation is a therapeutic option in limited strictures to avoid intestinal surgery, although there have been few reports regarding the long-term outcome. Patients and Methods: Balloon dilation was scheduled for 46 patients (26 women, 20 men; median age 34) with Crohn's-associated symptomatic and radiographically confirmed intestinal stenosis. The study plan envisaged up to four consecutive treatments within the first 2 months until relief of symptoms, and thereafter dilations depending on clinical requirements. Results: Dilation was not possible in seven of the 46 patients (15%), due to technical problems (n = 2), internal fistulas (n = 3), or absence of a stenosis (n = 2). Thirty-nine patients received at least one treatment. The site of obstruction was the ileocolonic anastomosis in 23 of the 39 patients (59%) and surgically untreated areas in 16 patients (41%). After the initial dilation series (median 1, interquartile range 1-2), strictures were traversed in 37 of the 39 patients (95%). During a median follow-up period of 21 months (range 3-98 months), 24 of the 39 patients (62%) underwent a repeat intervention, including 12 (31%) with repeat dilation, 11 (28%) with surgical resection, and one patient who received an intestinal stent. The cumulative percentages of patients without a repeat intervention or surgery at 6,12, 24, and 36 months were 68%, 48%, 36%, and 31%, and 97%, 91%, 84% and 75%, respectively. Two perforations and one case of severe bleeding were seen in the 73 dilation procedures (4%) performed. Conclusions: Endoscopic balloon dilation is a safe and effective method that allows surgery to be avoided in approximately 75% of patients with Crohn's-associated short intestinal strictures. However, recurrent symptoms frequently make it necessary to repeat the procedure.