Letter: endoscopic balloon dilatation or strictureplasty for stricturing Crohn's disease? Authors' reply.
- SourceAvailable from: Curt Tysk[Show abstract] [Hide abstract]
ABSTRACT: Bowel strictures are a major cause of morbidity, hospitalisation and surgery in Crohn's disease. We report short- and long-term efficacy and safety of endoscopic balloon dilation of strictures due to Crohn's disease. Retrospective study of patients who underwent endoscopic balloon dilation between 1987 and 2009. We performed 776 dilations, of which 621 (80%) were on anastomotic strictures, in 178 patients (94 women) with Crohn's disease. At first dilation, median (IQR) age of patients was 45 (37-56) years and disease duration 16 (8-22) years. Technical success rate was 689/776 (89%). A subset of 75 patients from the primary catchment area, with >5-year follow-up, underwent a total of 246 dilations. At 1-year follow-up, 60/75 (80%) patients had undergone no further intervention or one additional dilation only. At 3 and 5 years, corresponding figures were 43/75 (57%) and 39/75 (52%). Cumulative proportions of patients undergoing surgery at 1, 3 and 5 years were 13%, 28% and 36%. Complication rate per procedure for all 178 patients was 41/776 (5.3%), bowel perforation (n = 11, 1.4%), major bleeding requiring blood transfusion (n = 8, 1.0%), minor bleeding (n = 10, 1.3%) and abdominal pain or fever (n = 12, 1.5%). Ten patients underwent surgery due to complications (perforation n = 8, bleeding n = 2). There was no procedure-related mortality. Endoscopic balloon dilation is an efficacious and safe alternative to surgical resection of intestinal strictures in Crohn's disease. At 5-year follow-up, 52% of patients required no further or one additional dilation only, whereas 36% had undergone surgical resection. Complication frequency was low.Alimentary Pharmacology & Therapeutics 05/2012; 36(2):151-8. · 4.55 Impact Factor
- Alimentary Pharmacology & Therapeutics 08/2012; 36(4):403; author reply 404. · 4.55 Impact Factor
Letter: endoscopic balloon dilatation or
strictureplasty for stricturing Crohn's
disease? Authors’ reply
A. Gustavsson*,†, B. Blomberg*, M. Andersson‡,
J. Halfvarson*,†& C. Tysk*,†
*Division of Gastroenterology, Department of Medicine, Örebro
University Hospital, Örebro, Sweden.
†School of Health and Medical Sciences, Örebro University, Örebro,
‡Department of Surgery, Örebro University Hospital, Örebro, Sweden.
SIRS, We thank Drs Yamamoto and Shiraki for their let-
ter1about our article.2We agree with their comments
on the need for prospective trials on the optimal treat-
ment of intestinal strictures in Crohn's disease. More
studies on the best medical treatment for prevention of
recurrent stricture formation after an intestinal resection
are required. Furthermore, evidence-based recommenda-
tions on the best possible treatment of a short intestinal
stricture are absent.
Neither a strictureplasty nor endoscopic dilation cures
Crohn's disease. Hence, the best symptomatic treatment
in the long-term perspective needs to be assessed while
taking into account frequency of recurrence, complica-
tions, health-related quality of life and also health-eco-
nomic aspects. We agree on the need for prospective
controlled trials comparing strictureplasty with endo-
Declaration of personal interests: Anders Gustavsson has
served as a speaker for MSD. Jonas Halfvarson has
served as a speaker for MSD, Abbott and Renapharma
Vifor. Curt Tysk has served as a speaker for Tillotts
Pharma, Falk Pharma, Ferring, MSD and AstraZeneca.
Declaration of funding interests: The study was funded in
part by The Foundation for Clinical Research in Inflam-
matory Bowel Disease, United States and Uppsala-
Örebro Regional Research Council, Sweden.
1. Yamamoto T, Shiraki M. Letter: endoscopic balloon dilatation or
strictureplasty for stricturing Crohn's disease? Aliment Pharmacol
Ther 2012; 36: 403.
2. Gustavsson A, Magnuson A, Blomberg B, Andersson M,
Halfvarson J, Tysk C. Endoscopic dilation is an efficacious and
safe treatment of intestinal strictures in Crohn's disease. Aliment
Pharmacol Ther 2012; 36: 151–8.
Aliment Pharmacol Ther 2012; 36: 403-404
ª 2012 Blackwell Publishing Ltd
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