Repeated endoscopic dilation and needle-knife stricturotomy for Crohn's disease strictures

Background and Aims: Crohn's disease strictures are usually treated by a single endoscopic balloon dilation (EBD). We postulated repeat EBD and needle-knife stricturotomy (NKSt), together with inflammation controlled by intense drug therapy, may be more effective. Methods: Twenty-one patients with symptomatic strictures were randomized to a single EBD or intensive treatment with 3 balloon dilations 3 weeks apart and/or NKSt. Results: Of 21 patients, 2 of 5 (40%) undergoing a single EBD and 12 of 16 (72%) undergoing intensive treatment had symptom improvement (odds ratio, 4.49; 95% confidence interval, .54-37.4; P Z .164). Eleven patients received > 1 EBD without NKSt and 5 underwent > 1 NKSt. NKSt-treated patients and those with concurrent intensified drug treatment had the best outcomes. Conclusions: Treatment for Crohn's disease strictures with repeat dilations or stricturotomy is feasible and safe and may improve stricture outcomes. Concurrent intensified drug treatment to eliminate inflammation is also associated with improved outcomes.