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

Surg Endosc. 2014 Oct;28(10):2966-72. doi: 10.1007/s00464-014-3559-x. Epub 2014 May 23.

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.

MeSH terms

  • Abdominal Pain / etiology
  • Adult
  • Aged
  • Cecal Diseases / pathology
  • Cecal Diseases / therapy*
  • Colonic Diseases / etiology
  • Colonic Diseases / pathology
  • Colonic Diseases / therapy*
  • Constriction, Pathologic / therapy
  • Crohn Disease / complications*
  • Dilatation / adverse effects*
  • Dilatation / methods*
  • Endoscopy / adverse effects*
  • Endoscopy / methods*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Ileal Diseases / pathology
  • Ileal Diseases / therapy*
  • Intestinal Perforation / etiology
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult