A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn’s disease

Background Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the fa...

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Bibliographic Details
Published in:Journal of gastroenterology 2020-06, Vol.55 (6), p.615-626
Main Authors: Bamba, Shigeki, Sakemi, Ryosuke, Fujii, Toshimitsu, Takeda, Teruyuki, Fujioka, Shin, Takenaka, Kento, Kitamoto, Hiroki, Umezawa, Shotaro, Sakuraba, Hirotake, Inokuchi, Toshihiro, Fukata, Norimasa, Mizuno, Shinta, Yamashita, Masaki, Shinzaki, Shinichiro, Tanaka, Hiroki, Takedatsu, Hidetoshi, Ozaki, Ryo, Moriya, Kei, Ishii, Manabu, Kinjo, Tetsu, Ozeki, Keiji, Ooi, Makoto, Hayashi, Ryohei, Kakimoto, Kazuki, Shimodate, Yuichi, Kitamura, Kazuya, Yamada, Akihiro, Sonoda, Akira, Nishida, Yu, Yoshioka, Kyouko, Ashizuka, Shinya, Takahashi, Fumiaki, Shimokawa, Toshio, Kobayashi, Taku, Andoh, Akira, Hibi, Toshifumi
Format: Article
Language:English
Subjects:
Abdominal Surgery
Analysis
Balloon treatment
Cigarette smoking
Colorectal Surgery
Crohn's disease
Drug addiction
Gastroenterology
Hepatology
Medicine
Medicine & Public Health
Original Article—Alimentary Tract
Patients
Small intestine
Stricture
Surgery
Surgical Oncology
Tumor necrosis factor
Tumor necrosis factor-TNF
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Summary:Background Small bowel stricture is one of the most common complications in patients with Crohn’s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD. Methods Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available. Results A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length 
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-020-01670-2