Efficacy and safety of hydrostatic balloon dilation of ileocolonic Crohn's strictures: A prospective longterm analysis

Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Belgium.
Gut (Impact Factor: 14.66). 05/1995; 36(4):577-80. DOI: 10.1136/gut.36.4.577
Source: PubMed


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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    • "Study name Statistics for each study Event rate and 95% CI Event rate Lower limit Upper limit Total Blomberg 1991 Breysem 1992 Ramboer 1995 Couckuyt 1995 Hunter 2001 Brooker 2003 Thomas-Gibson 2003 Singh 2005 Foster 2008 Mueller 2010 Van Assche 2010 Scimea 2011 Nanda 2013 De Angelis 2013 Bahlme 2013 "
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    ABSTRACT: Background Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies.AimTo examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored.MethodsA systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics.ResultsTwenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60–78.8%), 90.6% (95% CI: 87.8–92.8%), 6.4% (95% CI: 5.0–8.2) and 3% (95% CI: 2.2–4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis.Conclusions Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
    Alimentary Pharmacology & Therapeutics 09/2015; 42(10). DOI:10.1111/apt.13388 · 5.73 Impact Factor
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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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    ABSTRACT: Stenosis is the most frequent complication during Crohn's disease. The lesion can be inflammatory, or due to a fibrosing or neoplastic process. The medical treatment with anti-inflammatory drugs is usually sufficient as first line treatment; fibrous lesions require endoscopic or surgical procedures while neoplastic lesions require surgery. A multidisciplinary approach (radiologic, medical, surgical and endoscopic) is needed. In a first part, we discuss the definition of stenosis and the modalities of imaging (particularly MRI) and of treatment (particularly with TNFalpha antagonists). Then we expose the strategy for the management of the most frequent clinical situations: occlusion, ileal inflammatory stenosis, stenosis of an ileocolonic anastomosis and chronic fibrous stenosis. The treatment decision takes into account the results of radiological assessment, CRP level and the effects of the previous treatments.
    Gastroentérologie Clinique et Biologique 10/2009; 33(10-11 Suppl):F75-81. · 1.14 Impact Factor
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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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    ABSTRACT: Background The short- and long-term results of balloon dilation therapy in Crohn's patients with non-anastomotic obstructive gastrointestinal lesions are investigated.
    Diagnostic and Therapeutic Endoscopy 02/2000; 6(2):67-75. DOI:10.1155/DTE.6.67
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