Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 382-390
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.382
Endoscopic balloon dilation for management of stricturing Crohn’s disease in children
Brianna McSorley, Robert A Cina, Candi Jump, Johanna Palmadottir, J Antonio Quiros
Brianna McSorley, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
Robert A Cina, Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
Candi Jump, Department of Pediatric Gastroenterology, Medical University of South Carolina, Charleston, SC 29425, United States
Johanna Palmadottir, Department of Pediatric Gastroenterology, MUSC Children's Hospital, Charleston, SC 29425, United States
J Antonio Quiros, Department of Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, New York, NY 10029, United States
Author contributions: McSorley B and Quiros JA collaborated in initial study design and performed all the data acquisition, data analysis, drafting of the manuscript and approval of the final submission; Cina RA, Jump C and Palmadottir J supported initial study conception, data interpretation and approval of final submission.
Institutional review board statement: Study was approved by the Institutional Review Board at the Medical University of South Carolina, IRB# Pro00081854.
Informed consent statement: The need for informed consent was waived by the Institutional Review Board at the Medical University of South Carolina due to the study being a retrospective chart review and causing no more than minimal risk to the patients.
Conflict-of-interest statement: The authors report no existing conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: J Antonio Quiros, MD, PhD, Professor, Department of Pediatric Gastroenterology and Nutrition, Mount Sinai Kravis Children's Hospital, One Gustave Levy Place, New York, NY 10029, United States. jose.quiros@mssm.edu
Received: March 24, 2021
Peer-review started: March 24, 2021
First decision: June 3, 2021
Revised: June 15, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: September 16, 2021
Processing time: 169 Days and 16 Hours
ARTICLE HIGHLIGHTS
Research background

Currently up to 75% of patients with Crohn's disease (CD) are expected to need surgery due to disease related complications. Intestinal fibrostenosing disease is a common complication and biologic therapy has not limited its appearance even with much improved clinical response rates. Due to a high risk for surgery, attempts to find alternatives to surgery need to be made. Endoscopic balloon dilation with adequate technique promises to have an important role in his area.

Research motivation

Endoscopic balloon dilation has already been shown to be efficacious in adults but no large case series involving pediatric patients exists currently in literature.

Research objectives

We aimed to evaluate the short and long term outcomes of CD who developed fibrostenosing disease and underwent endoscopic balloon dilation as primary or secondary therapy.

Research methods

This is a single-center case series in which all subjects who were diagnosed with diagnosed between 2012 and 2019 were included in the study, and those that developed fibrostenosing disease were identified. Their records were then reviewed for types of interventions performed and outcomes. Patients were classified into primary surgical or endoscopy-treated subjects and those that subsequently required surgery or endoscopy were thus classified. Demographic data included: age at diagnosis of CD, age at time of procedure, body mass index (BMI) at time of procedure, and race. Disease characteristics included: modality of CD diagnosis, time (years) from diagnosis of CD until the development of symptomatic strictures, the Paris classification of disease, and medication at the time of the procedure.

Research results

We identified 139 subjects diagnosed with CD in this study period. Of these patients, 25 (17%) were noted to have a fibrostenotic lesion anywhere in the small and large bowel. 13 (52%) underwent primary endoscopic therapy vs 12 (48%) who underwent surgical management. Of the patients who went to surgery, 4 (16%) had to have further endoscopic treatment after surgery, compared to just 2 (8%) of those who had endoscopy as primary therapy. Of note, 5 (20%) required just one endoscopic therapy session for resolution of their stricture.

Research conclusions

Endoscopic balloon dilation is a safe and effective treatment in children with CD-related fibrostenosing disease. Adequate patient selection is key to ensure a high success rate. Pediatric patients undergoing surgery for fibrostenosing disease should be cautioned that a 1 in 5 risk of requiring further endoscopic therapy is a distinct possibility.

Research perspectives

Our data suggested an interesting correlation between higher BMI and risk of stricturing disease. Pediatric patients with BMI > 85% and < 95% had a higher risk of complex strictures requiring surgery. This brings into new light publications associating an increase in visceral adipose tissue with intestinal inflammation through dysregulated leptin and adiponectin production.