Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2017; 23(41): 7397-7406
Published online Nov 7, 2017. doi: 10.3748/wjg.v23.i41.7397
Endoscopic balloon dilation of Crohn’s disease strictures-safety, efficacy and clinical impact
Susana Lopes, Eduardo Rodrigues-Pinto, Patrícia Andrade, Joana Afonso, Todd H Baron, Fernando Magro, Guilherme Macedo
Susana Lopes, Eduardo Rodrigues-Pinto, Patrícia Andrade, Fernando Magro, Guilherme Macedo, Gastroenterology Department, Faculty of Medicine, Hospital de São João, Porto 4200-319, Portugal
Joana Afonso, Fernando Magro, Department of Pharmacology and Therapeutics, University of Porto, Porto 4200-319, Portugal
Todd H Baron, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 4200, United States
Author contributions: Lopes S and Rodrigues-Pinto E contributed equally in the design, conception, analysis, and paper writing; Lopes S, Rodrigues-Pinto E and Magro F conceived and designed the study; Lopes S, Rodrigues-Pinto E and Andrade P collected and analyzed the data; Afonso J performed all laboratorial procedures; Rodrigues-Pinto E and Andrade P were responsible for statistical analysis; Baron TH, Magro F and Macedo G participated in critical revision of the manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of Centro Hospitalar São João, Porto, Portugal.
Informed consent statement: All patients gave informed written consent to participate in the study.
Conflict-of-interest statement: The authors of this manuscript have no conflict of interest to declare.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guilherme Macedo MD, PhD, Department of Gastroenterology, Centro Hospitalar São João, Alameda Professor Hernani Monteiro, Porto 4200-319, Portugal. guilhermemacedo59@gmail.com
Telephone: +351-22-5513600 Fax: +351-22-5513601
Received: August 16, 2017
Peer-review started: August 19, 2017
First decision: August 30, 2017
Revised: September 11, 2017
Accepted: September 20, 2017
Article in press: September 19, 2017
Published online: November 7, 2017
Abstract
AIM

To evaluate the incidence of anastomotic strictures after intestinal resection in Crohn’s disease (CD), demonstrate long-term efficacy and safety of endoscopic balloon dilation (EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence.

METHODS

Retrospective single tertiary center study based on prospectively collected data between 2010 and 2015 including anastomotic and non-anastomotic strictures.

RESULTS

29% of 162 CD patients included developed an anastomotic stricture. 43 patients with anastomotic strictures and 37 with non-anastomotic strictures underwent EBD; technical success was 97.7% and 100%, respectively, however, 63% and 41% needed repeat dilation during the 4.4-year follow-up. Longer periods between surgery and index colonoscopy and higher lactoferrin levels were associated with the presence of stricture after surgery. Calprotectin levels > 83.35 μg/g and current or past history of smoking were associated with a shorter time until need for dilation (HR = 3.877, 95%CI: 1.480-10.152 and HR = 3.041, 95%CI: 1.213-7.627). Anastomotic strictures had a greater need for repeat dilation (63% vs 41%, P = 0.047). No differences were found between asymptomatic and symptomatic cohorts. Disease recurrence diagnosis was only possible after EBD in a third of patients.

CONCLUSION

EBD is an effective and safe alternative to surgery, with a good short and long-term outcome, postponing or even avoiding further surgery. EBD may allow to diagnose disease recurrence in patients with no clinical signs/biomarkers of disease activity.

Keywords: Crohn’s disease, Endoscopic recurrence, Anastomotic strictures, Non-anastomotic strictures, Endoscopic balloon dilation

Core tip: This study evaluated the incidence of anastomotic strictures after intestinal resection in Crohn’s disease (CD), the long-term efficacy and safety of endoscopic balloon dilation (EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence. Almost one-third of CD patients developed an anastomotic stricture after ileocecal resection/right hemicolectomy. EBD was an effective and safe alternative to surgery, with a good short and long-term outcome, postponing or even avoiding further surgery. EBD also allowed to diagnose disease recurrence in patients with no clinical signs/biomarkers of disease activity. Longer intervals after surgery and higher lactoferrin levels were associated with anastomotic strictures; time until dilation was lower in patients with calprotectin levels > 83.35 μg/g and current/past history of smoking.