Colonoscopic balloon dilation of Crohn's strictures

Abstract

Objective To study the long-term outcomes of patients who have had endoscopic balloon dilation of Crohn's strictures. Design Retrospective case-note review over a 16-year period. Patients Patients with a Crohn's stricture causing obstructive symptoms and who had at least 6 months' follow-up data or a surgical outcome following dilation were sought; 59 patients (124 dilations) were identified. Intervention Patients all underwent endoscopic balloon dilation. Results Strictures were anastomotic in 53 patients (111 dilations) andde novoin six patients (13 dilations). The median stricture length was 3.0 cm. Median follow-up time was 29.4 months. Out of the total group, 41% of patients achieved long-term clinical benefit following dilation and in 17% after only a single dilation. The median number of dilations per patient was one. A total of 35 (59%) patients required surgery for their stricture during follow-up. There were two (1.6%) perforations as a result of dilation, one in an anastomotic stricture (managed conservatively) and one in a de-novo stricture (requiring surgery). There were no deaths. Conclusions Colonoscopic balloon dilation of Crohn's strictures can achieve long-term clinical benefit in many patients. Repeat dilations are justified in initial nonresponders. In this series, the procedure appears safe with low morbidity.