P325 Efficacy, safety, and long-term outcome of endoscopic dilation therapy for stricturing Crohn’s disease of the upper gastrointestinal tract: a combined analysis of 127 endoscopic balloon dilation procedures
D. Bettenworth*1, M. M. Mücke1, A. Singh2, R. Lopez3, F. Rieder4, 5
1University Hospital Münster, Department of Medicine B, Münster, Germany, 2Cleveland Clinic Foundation, Department of Hospital Medicine, Cleveland, Ohio, United States, 3Cleveland Clinic Foundation, Department of Quantitative Health Sciences, Cleveland, Ohio, United States, 4Cleveland Clinic Foundation, Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease Institute, Cleveland, Ohio, United States, 5Cleveland Clinic Foundation, Department of Pathobiology, Cleveland, Ohio, United States
Strictures are a frequent complication of Crohn’s disease (CD) and may occur in different segments along the gastrointestinal (GI) tract. In contrast to ileocecal strictures, endoscopic balloon dilation (EBD) for CD-associated strictures of the upper gastrointestinal (UGI) tract is rarely reported. We therefore performed a combined efficacy and safety analysis based on all published studies of EBD for UGI strictures available in the literature.
A formal systematic literature review was performed to assess all relevant citations found in Embase, Medline, and the Cochrane Library regarding EBD in upper GI CD. In addition, our own unpublished data was included in this analysis. Upper GI tract was defined as oesophagus, stomach, and duodenum up to the ligament of Treitz. Available technical and clinical variables were extracted from all studies available for a descriptive pooled data analysis. Weighted efficacy averages were calculated for sub-groups.
In the study, 13 publications, with a total of 73 CD patients and 127 performed dilation procedures were included. Stricture locations were duodenum n = 44, stomach n = 16, and oesophagus n = 6. Technical success rate was 94.1%, resulting in clinical efficacy in 90.9% of patients. The mean maximum balloon calibre used for dilation was 18.9 mm. Major complications with regard to dilation, defined as perforation, bleeding or dilation-related surgery, occurred in 2.8% of all procedures. During a mean follow-up period of 25.5 months, 49.6% of patients reported symptomatic recurrence, whereas 54.2% of patients needed to undergo re-dilation, and 31.3% required surgical intervention. The mean time to re-dilation was 7.4 months. Currently, there is no study available investigating the effect of concomitant therapeutic approaches such as steroid injection, cutting techniques, or stent placement on the outcome of EBD for upper GI strictures in CD patients.
EBD for CD-associated strictures of the upper gastrointestinal tract has a high rate of short-term technical and clinical success with robust long-term efficacy and acceptable complication rates. Therefore, EBD should be considered as an alternative to surgery in patients with CD-associated UGI strictures. Larger, controlled studies are needed to further evaluate EBD for upper GI strictures in CD patients.