Endoscopic balloon dilatation of Crohn's strictures: a safe method to defer surgery in selective cases

• Published in: ANZ journal of surgery 2017-12, Vol.87 (12), p.E240-E244
• Main Authors: Asairinachan, Ashwinna, An, Vinna, Daniel, Eric S., Johnston, Michael J., Woods, Rodney J.
• Format: Article
• Language: English
• Subjects: Balloon treatment; Bleeding; Complications; Crohn's disease; Crohn's stricture; Endoscopes; endoscopic balloon dilatation; Endoscopy; outcomes; Pain; Patients; Perforation; Safety; Stricture; Success; Surgery
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.13500

Background Endoscopic balloon dilatation (EBD) provides a valuable alternative to surgery for strictures in Crohn's disease (CD). Data are lacking regarding the factors that improve the safety and effectiveness of EBD in CD. The aim of this study is to determine the safety and efficacy of EBD and the clinical variables, which are predictive of successful treatment of CD strictures with EBD. Methods The records of all patients with CD in whom EBD was attempted between 2008 and 2013 were reviewed. Procedures were conducted at a single tertiary referral centre using a Boston Scientific CRE® TTS balloon. Technical success was defined as the ability to traverse the stricture with the endoscope and clinical success as the resolution of obstructive symptoms at review. Results Forty‐seven patients with a total of 58 strictures (19 primary and 39 anastomotic strictures) were treated with EBD with median follow‐up of 37 months. A total of 161 dilatation procedures were performed, with technical success reported in 139/158 (88%) cases and clinical success reported in 105/137 (76.7%) cases with complete data. Complications occurred in 7/161 dilatations (4.3% dilatations, 15% patients), three patients with perforation, one with acute bleeding and three admitted with abdominal pain. Eighteen of the 47 patients required surgery (38%). Strictures of