E. Aichinger1, K. Rothfuss1, M. Koch1, E. F. Stange1, J. G. Albert1, C. Schäfer1
1Robert Bosch Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Stuttgart, Germany
Endoscopic dilation of stenoses in patients with Crohn’s disease provides a less invasive way to avoid or reduce the number of bowel resections and, thereby, improve the quality of life. To the best our knowledge, only few studies with small patient numbers are available on long-term results.
Patients with Crohn's Disease above the age of 18, who underwent endoscopic therapy of gastrointestinal symptomatic stenoses in our hospital from January 2008 to May 2018, were enrolled in the study. The therapy was defined as clinically successful if endoscopic re-treatment was not required within 30 days.
We performed 562 endoscopic interventions in 163 patients (n = 82 women/n = 81 men, mean age = 46 years, mean disease duration until first endoscopic therapy = 18 years) with a mean of 3.4 interventions per patient (range 1–76). In 75 patients (46%) only one endoscopic treatment was performed; 88 patients received a total of 399 re-endoscopies (mean 4.5 per patient). Follow-up information was available for 136 of 163 patients (83.4%) with an average period of 36 months (range 2–3567 days). Dilation procedures were performed in the ileocaecal region (230 in 104 patients), in the colon (126 in 36 patients), oesophagus (108 in 2 patients), upper small intestine (83 in 15 patients), lower small intestine (11 in 5 patients) or stomach (4 in 1 patient). We treated 95 patients with anastomotic stenoses (58.3%) and 68 with non-anastomotic stenoses (41.7%). Therapeutic methods included 556 hydrostatic balloon dilations (n = 386 Through-The-Scope balloon dilations (TTS), n = 170 TTS + over-the-wire dilations), five bougienage dilations and in one case the insertion of a covered metal stent. The dilation was performed to an average width of 14.3 mm (range 7 to 20 mm); clinical success was documented in 440/562 procedures (78.3%). We observed complications in 11 cases (1.9% of all endoscopies), resulting in bleeding (n = 6), infection (n = 1) or perforation (n = 4) which lead to an extension of hospital stay (n = 8), antibiotic therapy (n = 1) or surgery (n = 2). Irrespective of complications, 48 out of 163 patients (29.4%) had to undergo surgical resection of the stenosis until the end of the study period.
Endoscopic therapy of symptomatic stenoses in Crohn's Disease is safe and effective, with complications occurring in only 1.9% of all endoscopic procedures. Repeated dilation is effective and only 29.4% of patients had to undergo surgical resection of the stenosis in the further course of disease.