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Outcome and complications of endoscopic balloon dilatations in various types of ileocaecal and colonic stenosis in patients with Crohn’s disease

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Abstract

Aim

We examined the outcome and the complications of endoscopic balloon dilatation (EBD) of ileocaecal and colonic strictures due to Crohn’s disease.

Methods

We examined 237 dilatation procedures in 77 patients with symptomatic ileocaecal and colonic stenosis regarding outcome, individual perforation risk, the need for further interventions, and other complications within a 10 years observation period.

Results

In 50 of 77 patients (64.9 %), endoscopic dilatation procedures were successful within a median follow-up period of 24 months (25th and 75th percentile 10–38.5 months). Thirty five patients (45.5 %) were successfully dilated with only one endoscopic procedure, while the remaining patients required two or more EBDs. Albeit the EBD, 27 patients of the whole cohort (35.1 %) underwent surgical repair of the stenosis in due course. Overall complication rate was 7.6 %, with postdilatation bleeding in 1.7 % and abdominal pain longer than 24 h in 4.2 %. Perforation occurred in 4 of 77 patients (5.2 %), resulting in a perforation rate of 1.7 % per intervention, or, more importantly, for the individual patient in a long-term perforation rate of 5.2 % per patient, respectively.

Discussion

Endoscopic balloon dilatation (EBD) is a safe and effective approach to ileocaecal and colonic stenosis in approximately 65 % of Crohn’s disease patients. Even in case of recurrence, further endoscopic treatments can be undertaken. The perforation rate depending on the number of interventions is low, but for the individual patient a cumulative per patient perforation risk of 5.2 % in the long-term should be considered during patient information and decisions for or against surgical interventions.

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Literature

  1. McKaig BC, Hughes K, Tighe PJ, Mahida YR (2002) Differential expression of TGF-beta isoforms by normal and inflammatory bowel disease intestinal myofibroblasts. Am J Physiol Cell Physiol 282:C172–C182

    Article  PubMed  CAS  Google Scholar 

  2. Beddy D, Mulsow J, Watson RW, Fitzpatrick JM, O’connell PR (2006) Expression and regulation of connective tissue growth factor by transforming growth factor beta and tumour necrosis factor alpha in fibroblasts isolated from strictures in patients with Crohn’s disease. Br J Surg 93:1290–1296

    Article  PubMed  CAS  Google Scholar 

  3. Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, Gendre JP (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8:244–250

    Article  PubMed  Google Scholar 

  4. Gasche C, Schölmerich J, Brynskov J, D’Haens G, Hanauer SB, Irvine EJ (2002) A simple classification of Crohn’s disease: report of Working Party for the World Congress of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 6:8–15

    Google Scholar 

  5. Solberg IC, Vatn MH, Høie O, Stray N, Sauar J, Jahnsen J, Moum B, Lygren I (2007) IBSEN Study Group Clinical course in Crohn’s disease: results of a Norwegian population based ten-year follow-up study. Clin Gastroenterol Hepatol 5:1430–1438

    Article  PubMed  Google Scholar 

  6. Oberhuber G, Stangl PC, Vogelsang H, Schober E, Herbst F, Gasche C (2000) Significant association of strictures and internal fistula formation in Crohn’s disease. Virchows Arch 437:293–297

    Article  PubMed  CAS  Google Scholar 

  7. Vrabie R, Irwin GL, Friedel D (2012) Endoscopic management of inflammatory bowel disease strictures. World J Gastrointest Endoscopy 16(4(11)):500–505

    Article  Google Scholar 

  8. Krupnick AS, Morris JB (2000) The long-term results of resection and multiple resections in Crohn’s disease. Semin Gastrointest Dis 11:41–51

    PubMed  CAS  Google Scholar 

  9. Hahn M, Raithel M, Hagel A, Biermann T, Manger B (2012) Chronic calcium pyrophosphate crystal inflammatory arthritis induced by extreme hypomagnesemia in short bowel syndrome. BMC Gastroenterology 12:129–132

    Article  PubMed  PubMed Central  Google Scholar 

  10. Legnani PE, Kornbluth A (2002) Therapeutic options in the management of strictures in Crohn’s disease. Gastrointest Endosc Clin N Am 12:589–603

    Article  PubMed  Google Scholar 

  11. Tichansky D, Cagir B, Yoo E, Marcus SM, Fry RD (2000) Strictureplasty for Crohn’s disease: meta-analysis. Dis Colon Rectum 43:911–919

    Article  PubMed  CAS  Google Scholar 

  12. Yamamoto T, Fazio VW, Tekkis PP (2007) Safety and efficacy of strictureplasty for Crohn’s disease: a systematic review and meta-analysis. Dis Colon Rectum 50:1968–1986

    Article  PubMed  Google Scholar 

  13. Blomberg B, Rolny P, Jarnerot G (1991) Endoscopic treatment of anastomotic strictures in Crohn’s disease. Endoscopy 23:195–198

    Article  PubMed  CAS  Google Scholar 

  14. Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P (1995) Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn’s strictures: a prospective long term analysis. Gut 36:577–580

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Hassan C, Zullo A, De Francesco V, Ierardi E, Giustini M, Pitidis A, Taggi F, Winn S, Morini S (2007) Systematic review: endoscopic dilatation in Crohn’s disease. Aliment Pharmacol Ther 26(11–12):1457–1464

    Article  PubMed  CAS  Google Scholar 

  16. Hoffmann JC, Heller F, Faiss S, von Lampe B, Kroesen AJ, Wahnschaffe U, Schulzke JD, Zeitz M, Bojarski C (2008) Through the endoscope balloon dilation of ileocolonic strictures: prognostic factors, complications, and effectiveness. Int J Colorectal Dis 23(7):689–696

    Article  PubMed  Google Scholar 

  17. Thomas-Gibson S, Brooker JC, Hayward CM, Shah SG, Williams CB, Saunders BP (2003) Colonoscopic balloon dilation of Crohn’s strictures: a review of long-term outcomes. Eur J Gastroenterol Hepatol 15:485–488

    PubMed  Google Scholar 

  18. Morini S, Hassan C, Lorenzetti R, Zullo A, Cerro P, Winn S, Giustini M, Taggi F (2003) Long-term outcome of endoscopic pneumatic dilatation in Crohn’s disease. Dig Liver Dis 35:893–897

    Article  PubMed  CAS  Google Scholar 

  19. Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G (1984) Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut 25:665–672

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Mueller T, Rieder B, Bechtner G, Pfeiffer A (2010) The response of Crohn’s strictures to endoscopic balloon dilation. Aliment Pharmacol Ther 31(6):634–639

    Article  PubMed  CAS  Google Scholar 

  21. Scimeca D, Mocciaro F, Cottone M, Montalbano LM, D’Amico G, Olivo M, Orlando R, Orlando A (2011) Efficacy and safety of endoscopic balloon dilation of symptomatic intestinal Crohn’s disease strictures. Dig Liver Dis 43(2):121–125

    Article  PubMed  Google Scholar 

  22. Sabate JM, Villarejo J, Bouhnik Y, Allez M, Gornet JM, Vahedi K, Modigliani R, Lémann M (2003) Hydrostatic balloon dilatation of Crohn’s strictures. Aliment Pharmacol Ther 18:409–413

    Article  PubMed  Google Scholar 

  23. Ferlitsch A, Reinisch W, Puspok A, Dejaco C, Schillinger M, Schöfl R, Pötzi R, Gangl A, Vogelsang H (2006) Safety and efficacy of endoscopic balloon dilation for treatment of Crohn’s disease strictures. Endoscopy 38:483–487

    Article  PubMed  CAS  Google Scholar 

  24. Thienpont C, D’Hoore A, Vermeire S, Demedts I, Bisschops R, Coremans G, Rutgeerts P, Van Assche G (2010) Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut 59(3):320–324

    Article  PubMed  CAS  Google Scholar 

  25. Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C (2013) Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn’s disease. Aliment Pharmacol Ther 37(4):430–437

    Article  PubMed  CAS  Google Scholar 

  26. Yamamoto T, Keighley MR (2000) Smoking and disease recurrence after operation for Crohn’s disease. Br J Surg 87:398–404

    Article  PubMed  CAS  Google Scholar 

  27. Griffiths AM (2005) Enteral nutrition in the management of Crohn’s disease. JPEN J Parenter Enteral Nutr 29(4 Suppl):S108–S112

    Article  PubMed  Google Scholar 

  28. Schwab D, Raithel M, Hahn EG (1998) Enteral nutrition in acute Crohn disease. Z Gastroenterol 36(11):983–995

    PubMed  CAS  Google Scholar 

  29. Stienecker K, Gleichmann D, Neumayer U, Glaser HJ, Tonus C (2009) Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn’s disease: a prospective study. World J Gastroenterol 15(21):2623–2627

    Article  PubMed  PubMed Central  Google Scholar 

  30. Singh VV, Draganov P, Valentine J (2005) Efficacy and safety of endoscopic balloon dilation of symptomatic upper and lower gastrointestinal Crohn’s disease strictures. J Clin Gastroenterol 39:284–290

    Article  PubMed  Google Scholar 

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Disclosures

Hagel AF, Hahn A, Dauth W, Matzel K, Konturek P, Neurath MF, and Raithel M, have no conflicts of interest or financial ties concerning this study to declare.

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Authors and Affiliations

  1. Department of Medicine I, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany

    Alexander F. Hagel, Anna Hahn, Markus F. Neurath & Martin Raithel

  2. Institute for Employment Research, Nuremberg, Regensburger Straße 104, 90478, Nuremberg, Germany

    Wolfgang Dauth

  3. Department Surgery, University of Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany

    Klaus Matzel

  4. Thüringen-Kliniken, Rainweg 68, 07318, Saalfeld, Germany

    Peter C. Konturek

Authors
  1. Alexander F. Hagel
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  2. Anna Hahn
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  3. Wolfgang Dauth
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  4. Klaus Matzel
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  7. Martin Raithel
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Correspondence to Alexander F. Hagel.

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For the conduct of this study, no grants or funding were obtained.

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Hagel, A.F., Hahn, A., Dauth, W. et al. Outcome and complications of endoscopic balloon dilatations in various types of ileocaecal and colonic stenosis in patients with Crohn’s disease. Surg Endosc 28, 2966–2972 (2014). https://doi.org/10.1007/s00464-014-3559-x

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  • DOI: https://doi.org/10.1007/s00464-014-3559-x

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