Aims To evaluate outcomes following endoscopic balloon dilatation (EBD) of strictures in patients with Crohn’s disease (CD).
Methods A retrospective study of 45 EBDs on 23 patients. Details about the stricture and dilatation were obtained from endoscopy reports. Charts were reviewed for information about re-admission, escalation of medical therapy, repeat EBD, and surgery.
Results 98 % of EBDs were successful without complications. One failed due to inability to pass the guidewire. Within 30 days of EBD, 9 % were admitted, three for management of flares and one for C.difficile infection.
Tab. 1
Outcomes Following EBD
|
No Further Intervention
|
Repeat Dilatation
|
Surgery
|
|
Year 1
|
68 %
|
12 %
|
20 %
|
|
Year 3
|
42 %
|
29 %
|
29 %
|
|
Year 5
|
28 %
|
28 %
|
44 %
|
The range of diameter of dilatation was 8–20mm. The median was 15mm. In dilatations >15mm 50 % required surgery, and <15mm 35 % required surgery. When EBD was applied to anastomotic strictures, 33 % required surgery, compared to 45 % in native strictures.
Triamcinolone was used in 9 % of EBDs - 4 % of first dilatations and 17 % of repeat dilatations. Where medical therapy was escalated within 12 months of EBD, reflecting active disease, 50 % avoided surgery.
Conclusions EBD of strictures in CD is a safe treatment which can delay and reduce the need for surgery. Following EBD, 56 % of patients did not require surgical intervention at 5 years. As studies suggest, EBD of anastomotic strictures yielded a better response than when applied to native strictures. However contrary to other studies, surgical intervention was less frequent following EBD with a smaller balloon diameter. Further determination of predictors of positive outcomes would allow for more selective application of EBD.
Citation: Walker C, Carroll A, McKearney E et al. eP18 AN EVALUATION OF OUTCOMES FOLLOWING ENDOSCOPIC BALLOON DILATATION OF STRICTURES IN CROHN’S DISEASE PATIENTS IN A TERTIARY IRISH HOSPITAL. Endoscopy 2021; 53: S102.
