Complete mucosal healing prevents stricture progression after endoscopic balloon dilation in Crohn's disease

Objectives: Endoscopic balloon dilation (EBD) is an effective treatment for intestinal strictures in Crohn's disease (CD). However, restenosis often occurs and requires repeat EBD or surgery. Previous studies have seldom examined restenosis with respect to stricture diameter, leaving the factors contributing to post-EBD restenosis unclear. Our retrospective study indicated that complete mucosal healing significantly reduces restenosis after EBD in CD-related small intestinal strictures. This prospective study aimed to validate these findings by accurately measuring stricture diameters in patients with CD. Methods: We conducted a single-center prospective study of patients with CD and small intestinal strictures. The patients underwent an EBD session between June 2022 and December 2023. Stricture diameters were measured using a calibrated small-caliber-tip transparent hood. Multivariate analysis was performed to identify factors influencing stricture progression. Results: This study included 41 patients (33 men). The number of strictures detected between sessions increased from 159 to 170. The average diameter of all strictures and the narrowest stricture per patient showed slight increases. However, 73% of patients experienced stricture progression. The presence of ulcers between sessions was identified as a significant risk factor for stricture progression (odds ratio 7.59, p = 0.031). Patients achieving complete mucosal healing demonstrated a significant increase in the narrowest stricture diameter (+1.5 mm, p = 0.00089). Conclusions: Complete mucosal healing is crucial for preventing stricture progression after EBD in patients with CD-related small intestinal strictures.