Balloon dilation relieves strictures in Crohn’s disease patients
MedWire News: Crohn's disease patients may benefit from endoscopic balloon dilation of symptomatic disease strictures, offering an alternative to surgery that may be repeated in recurrent intestinal obstructions, say Italian researchers.
Crohn's disease is frequently complicated by obstructive symptoms secondary to the development of intestinal strictures. There is no specific conservative approach to the treatment of strictures, and intestinal resection has been the operation of choice, with repeated resections necessary in some patients.
To determine the efficacy and safety of endoscopic hydrostatic balloon dilation, Daniela Scimeca and colleagues from "V Cervello" Hospital in Palermo performed the procedure in 37 Crohn's disease patients with 39 intestinal symptomatic strictures, 35 of which had occurred ostoperatively.
Dilation was performed using a Rigiflex through-the-scope balloon (Boston Scientific Corporation, Natick, Massachusetts, USA). Clinical success was defined as a patient remaining asymptomatic without requiring surgery or further endoscopic dilation.
Technical success was achieved in 31 (84%) patients. Of these, 19 remained symptom-free, one underwent surgery, and 11 received a further dilation after a mean of 19.8 months due to the recurrence of obstructive symptoms.
After a mean follow-up of 26.3 months, the clinical success rate after a single dilation was 51%, and the global benefit rate was 89%, the team reports in the journal Digestive and Liver Disease. The proportion of symptom-free interval patients at 12, 24, and 36 months was 76%, 55%, and 46%, respectively.
Overall, four patients underwent operations during follow-up. On univariate analysis, technical success during dilation was the only variable that was significantly associated with surgery during follow-up, at a hazard ratio of 0.099. There were neither mild nor severe complications related to the procedure.
The team concludes: "The result of our report shows that balloon dilation is a safe and effective procedure to treat symptomatic strictures in patients with Crohn's disease.
"An increase in the rate of symptomatic recurrence can be expected at the second and third year after the dilation, but the procedure could be safely repeated and surgical intervention is limited to a low percentage of patients."
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By Liam Davenport