Article

Efficacy and safety of hydrostatic balloon dilatation of ileo-colonic Crohn's strictures: A prospective long-term analysis

Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Belgium.
Gut (Impact Factor: 13.32). 05/1995; 36(4):577-80. DOI: 10.1136/gut.36.4.577
Source: PubMed

ABSTRACT Preliminary reports have suggested that dilatation using hydrostatic through the scope balloons may be useful for the treatment of Crohn's strictures, A prospective longterm follow up (mean (SD) 33.6 (11.2) months) was carried out in 55 Crohn's patients with 59 ileocolonic strictures submitted to 78 dilatation procedures. Hydrostatic balloons were used (Rigiflator, Microvasive) with a diameter of 18 mm on inflation. As soon as the balloons became available dilatation up to a diameter of 20 and 25 mm was attempted. The dilatations were performed under general anaesthesia using propofol (Diprivan). The patients were kept for one night in the hospital after dilatation. Seventy (90%) procedures were technically successful and passage of the stricture with a 13.6 mm diameter colonoscope was possible after 73% of the dilatations. Complications occurred in six patients (11%; 8% of procedures), including sealed perforations (n = 2), retroperitoneal perforations (n = 2), and intraperitoneal perforations (n = 2). Two of the patients were treated surgically with a one stage resection of the stricture and recovered uneventfully. Four patients were treated conservatively with intravenous fluids and antibiotics. There was no mortality. Dilatation completely relieved obstructive symptoms in 20 patients after one procedure, in another 14 patients after two (n = 13) or three (n = 1) dilatations. Total longterm success rate was 34 of 55 patients (62%). Nineteen patients (38%) were operated on because of persistent obstructive symptoms. The data show that endoscopic dilatation using the through the scope hydrostatic balloon system relieves obstructive symptoms resulting from ileocolonic Crohn's strictures. The procedure, however, carries a definite risk of perforation.

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    • "Une méta-analyse de 13 études incluant 347 malades (dans 74 % des cas atteints de sténoses postopératoires) a montré que le succès technique était de 86 % et l'efficacité clinique (pour éviter une chirurgie) de 58 % (obtenue dans 59 % des cas en une seule dilatation, 22 % des cas après 2 dilatations et 19 % des cas après trois) [22]. Une récidive des symptômes est observée dans 40 à 53 % des cas à 1 an et dans 62 à 70 % des cas à 5 ans [21] [23]; une nouvelle dilatation est alors possible [24]. Des complications majeures sont rapportées dans 2 % des cas, dominées par la perforation. "
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    • "Firm conclusions or recommendations have not been drawn concerning balloon dilation because there have been few large long-term studies on the results of balloon dilation in Crohn's patients with obstructive gastrointestinal lesions [27] [30]. The aim of the present study is to clarify the long-term efficacy and results of balloon dilation in forty-five patients prospectively, especially in patients with no prior surgery. "
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