Endoscopic balloon dilation of Crohn’s disease strictures-safety, efficacy and clinical impact

Table 1 Baseline characteristics of crohn’s disease patients with prior ileocecal resection/right hemicolectomy

Characteristic	CD (n = 162)
Female/male (n)	77/85
Disease duration in years (median; min-max)	17.1 (3.3-52.1)
Follow-up time in years (median; min-max)	4.4 (1.3-6.8)
Time between surgery and index colonoscopy in years (median; min-max)	7.7 (0.3-37.6)
Age at index colonoscopy (mean; standard deviation)	42.6 (± 13.4)
Montreal classification (n; %)
Age at diagnosis
A1	25 (15.5)
A2	116 (72)
A3	20 (12.4)
Disease location
L1	89 (54.9)
L2	9 (5.6)
L3	55 (34)
L1-4	7 (4.3)
L3-4	2 (1.2)
Behavior
B1	6 (3.7)
B2	77 (47.5)
B3	79 (48.8)
Perianal disease	38 (23.5)
Smoking habits (n; %)
Non-smoker	86 (55.1)
Ex-smoker	34 (21.8)
Current smoker	36 (23.1)
Medication at index colonoscopy
Thiopurines	111 (68.5)
Anti-TNFα	59 (36.4)

TNFα: Tumor necrosis factor α.

Table 2 Univariate and multivariate analysis of risk factors for need for dilation after surgery

Risk factors	Univariate analysis	Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
Significant in univariate and multivariate analysis
Time between surgery and index colonoscopy	1.006	1.003-1.010	0.001	1.007	1.001-1.013	0.027
Lactoferrin levels	1.010	1.000-1.021	0.049	1.012	1.000-1.024	0.043
Significant in univariate analysis
Subocclusive symptoms	6.155	2.546-14.880	< 0.001	-	-	0.180
No medical treatment with thiopurines	2.611	1.282-5.319	0.008	-	-	0.500
Age at index colonoscopy	1.028	1.002-1.055	0.033	-	-	0.932
Not significant in univariate nor multivariate analysis
Smoking status	1.877	0.912-3.861	0.087
B2 behavior	1.221	0.619-2.408	0.565
B3 behavior	0.895	0.454-1.767	0.750
Perianal disease	1.376	0.632-2.996	0.421
Anti-TNF therapy	0.893	0.443-1.799	0.751
C-reactive protein levels	0.975	0.935-1.016	0.229
Calprotectin levels	1.001	1.000-1.002	0.125
Harvey-Bradshaw index	1.111	0.936-1.318	0.229
Disease duration	1.002	1.000-1.005	0.089

OR: Odds ratio; CI: Confidence interval; B1: Non-stenosing and non-penetrating behaviour; B2: Stenosing behaviour; B1: Penetrating behaviour; TNF: Tumor necrosis factor.

Table 3 Baseline characteristics comparison between anastomotic and non-anastomotic strictures n (%)

Characteristic	Anastomotic strictures (n = 43)	Non-anastomotic strictures (n = 37)	P value
Female/male (n)	19/24	22/15	0.173
Disease duration in years (median; min-max)	19.2 (5.7-52.1)	16.3 (3.0-45.3)	0.236
Follow-up since 1st dilation in years (median; min-max)	4.4 (1.3-6.8)	2.9 (1.2-6.5)	< 0.001
Time between 1st and 2nd dilation in days (median; min-max)	453.5 (152-1362)	368 (157-1705)	0.796
Age at index colonoscopy (mean; standard deviation)	44.9 (± 12.2)	39 (± 12.2)	0.035
Montreal classification
Age at diagnosis			0.368
A1	6 (14)	4 (12.9)
A2	29 (67.4)	25 (80.6)
A3	8 (18.6)	2 (6.5)
Disease location			0.057
L1	23 (53.5)	9 (29)
L2	1 (2.3)	4 (12.9)
L3	17 (39.5%)	14 (45.2%)
L1-4	2 (4.7%)	3 (9.7%)
L3-4	-	1 (3.2%)
Behavior
B1	1 (2.3)	4 (12.9)	0.071
B2	22 (51.2)	19 (61.3)	0.387
B3	20 (46.5)	8 (25.8)	0.07
Perianal disease	12 (27.9)	9 (29)	0.916
Smoking habits			0.635
Non-smoker	22 (52.4)	11 (44)
Ex-smoker	8 (19)	9 (36)
Current smoker	12 (28.6)	5 (20)
Medication at index colonoscopy
Thiopurines	23 (53.5)	25 (67.6)	0.200
Anti-TNFα	17 (39.5)	19 (51.4)	0.289
Obstructive symptoms	15 (35.7)	10 (27.8)	0.454
C-reactive protein	2.8 (0.3-18.4)	6.95 (0.2-35.5)	0.126
Calprotectin	103.5 (5.9-1356)	283 (166-321)	0.789
Lactoferrin	7.66 (1.05-204.4)	10.7 (7.1-22.7)	0.429
Need to repeat dilation	27 (62.8)	15 (40.5)	0.047

TNFα: Tumor necrosis factor α.

Table 4 Baseline disease characteristics, endoscopic balloon dilation procedure, need for further dilations, escalation of medical therapy and need for surgery between asymptomatic and symptomatic cohorts n (%)

Characteristic	Asymptomatic strictures1 (n = 53)	Symptomatic strictures1 (n = 25)	P value
Female/male (n)	25/28	16/9	0.165
Disease duration in years (median; min-max)	17.9 (2.9-45.3)	19.9 (5.3-52.1)	0.955
Follow-up since 1st dilation in years (median; min-max)	3.1 (1.3-6.8)	3.9 (2.1-6.7)	0.068
Time between 1st and 2nd dilation in days (median; min-max)	668 (157-2074)	877 (152-2242)	0.790
Age at index colonoscopy (mean ± SD)	41.7 ± 13.8	43 ± 9.3	0.425
Montreal classification
Age at diagnosis			0.998
A1	7 (14)	3 (13.6)
A2	36 (72)	16 (72.7)
A3	7 (14)	3 (13.6)
Disease location			0.319
L1	22 (44)	9 (40.9)
L2	5 (10)	-
L3	21 (42)	9 (40.9)
L1-4	1 (2)	4 (18.2)
L3-4	1 (2)	-
Behavior			0.833
B1	4 (8)	1 (4.5)
B2	28 (56)	12 (54.5)
B3	18 (36)	9 (40.9)
Perianal disease	15 (30)	6 (27.3)	0.815
Smoking habits			0.761
Non-smoker	24 (52.2)	8 (42.1)
Ex-smoker	8 (17.4)	4 (21.2)
Current smoker	14 (30.4)	7 (36.8)
Previous surgery (ileocecal resection/right hemicolectomy)	27 (50.9)	15 (60)	0.454
Medication at index colonoscopy
Thiopurines	33 (62.3)	13 (52)	0.390
Anti-TNFα	21 (39.6)	14 (56)	0.175
Combo	13 (24.5)	9 (36)	0.293
C-reactive protein	6.2 (0.2-35.5)	3.2 (0.3-19.4)	0.351
Calprotectin	107 (18.2-837)	340 (5.9-1356)	0.449
Lactoferrin	7.1 (1.1-102.6)	37.6 (4.0-204)	0.071
Therapeutic success	52 (98.1)	25 (100%)	0.377
Balloon diameter (median; min - max)	18 (10-18)	18 (13.5-18)	0.201
Adverse events	0 (0)	1 (4)	0.129
Need to repeat dilation	27 (50.9)	15 (60)	0.454
Number of dilations (median; min - max)	2 (1-5)	2 (1-5)	0.463
Escalation of medical therapy after dilation	13 (27.7)	8 (34.8)	0.541
Need for surgery after dilation	2 (4)	1 (4.2)	0.973

¹Two patients had no information regarding presence of obstructive symptoms (one in each group). TNFα: Tumor necrosis factor α.