Safety and efficacy of endoscopic balloon dilation for treatment of Crohn's disease strictures

被引:90
作者
Ferlitsch, A.
Reinisch, W.
Puespoek, A.
Dejaco, C.
Schillinger, M.
Schoefl, R.
Poetzi, R.
Gangl, A.
Vogelsang, H.
机构
[1] Med Univ Vienna, Dept Internal Med 4, Div Gastroenterol & Hepatol, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Internal Med 2, Div Angiol, A-1090 Vienna, Austria
关键词
D O I
10.1055/s-2006-924999
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Study Aims: Strictures are a substantial cause of morbidity in patients with Crohn's disease. Endoscopic balloon dilation is a therapeutic option in limited strictures to avoid intestinal surgery, although there have been few reports regarding the long-term outcome. Patients and Methods: Balloon dilation was scheduled for 46 patients (26 women, 20 men; median age 34) with Crohn's-associated symptomatic and radiographically confirmed intestinal stenosis. The study plan envisaged up to four consecutive treatments within the first 2 months until relief of symptoms, and thereafter dilations depending on clinical requirements. Results: Dilation was not possible in seven of the 46 patients (15%), due to technical problems (n = 2), internal fistulas (n = 3), or absence of a stenosis (n = 2). Thirty-nine patients received at least one treatment. The site of obstruction was the ileocolonic anastomosis in 23 of the 39 patients (59%) and surgically untreated areas in 16 patients (41%). After the initial dilation series (median 1, interquartile range 1-2), strictures were traversed in 37 of the 39 patients (95%). During a median follow-up period of 21 months (range 3-98 months), 24 of the 39 patients (62%) underwent a repeat intervention, including 12 (31%) with repeat dilation, 11 (28%) with surgical resection, and one patient who received an intestinal stent. The cumulative percentages of patients without a repeat intervention or surgery at 6,12, 24, and 36 months were 68%, 48%, 36%, and 31%, and 97%, 91%, 84% and 75%, respectively. Two perforations and one case of severe bleeding were seen in the 73 dilation procedures (4%) performed. Conclusions: Endoscopic balloon dilation is a safe and effective method that allows surgery to be avoided in approximately 75% of patients with Crohn's-associated short intestinal strictures. However, recurrent symptoms frequently make it necessary to repeat the procedure.
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页码:483 / 487
页数:5
相关论文
共 18 条
[1]   ENDOSCOPIC TREATMENT OF ANASTOMOTIC STRICTURES IN CROHNS-DISEASE [J].
BLOMBERG, B ;
ROLNY, P ;
JARNEROT, G .
ENDOSCOPY, 1991, 23 (04) :195-198
[2]   Recurrence after abdominal surgery for Crohn's disease - Relationship to disease site and surgical procedure [J].
Borley, NR ;
Mortensen, NJM ;
Chaudry, MA ;
Mohammed, S ;
Warren, BF ;
George, BD ;
Clark, T ;
Jewell, DP ;
Kettlewell, MGW .
DISEASES OF THE COLON & RECTUM, 2002, 45 (03) :377-383
[3]   Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: A retrospective case series [J].
Brooker, JC ;
Beckett, CG ;
Saunders, BP ;
Benson, MJ .
ENDOSCOPY, 2003, 35 (04) :333-337
[4]   Long-term evolution of disease behavior of Crohn's disease [J].
Cosnes, J ;
Cattan, S ;
Blain, A ;
Beaugerie, L ;
Carbonnel, F ;
Parc, R ;
Gendre, JP .
INFLAMMATORY BOWEL DISEASES, 2002, 8 (04) :244-250
[5]   EFFICACY AND SAFETY OF HYDROSTATIC BALLOON DILATATION OF ILEOCOLONIC CROHNS STRICTURES - A PROSPECTIVE LONG-TERM ANALYSIS [J].
COUCKUYT, H ;
GEVERS, AM ;
COREMANS, G ;
HIELE, M ;
RUTGEERTS, P .
GUT, 1995, 36 (04) :577-580
[6]   Colonoscopic hydrostatic balloon dilatation of Crohn's strictures [J].
Dear, KLE ;
Hunter, JO .
JOURNAL OF CLINICAL GASTROENTEROLOGY, 2001, 33 (04) :315-318
[7]  
Dietz DW, 2001, J AM COLL SURGEONS, V192, P330, DOI 10.1016/S1072-7515(01)00775-X
[8]   A simple classification of Crohn's disease: Report of the Working Party for the world congresses of gastroenterology, Vienna 1998 [J].
Gasche, C ;
Scholmerich, J ;
Brynskov, J ;
D'Haens, G ;
Hanauer, SB ;
Irvine, EJ ;
Jewell, DP ;
Rachmilewitz, D ;
Sachar, DB ;
Sandborn, WJ ;
Sutherland, LR .
INFLAMMATORY BOWEL DISEASES, 2000, 6 (01) :8-15
[9]   PERFORATING AND NON-PERFORATING INDICATIONS FOR REPEATED OPERATIONS IN CROHNS-DISEASE - EVIDENCE FOR 2 CLINICAL FORMS [J].
GREENSTEIN, AJ ;
LACHMAN, P ;
SACHAR, DB ;
SPRINGHORN, J ;
HEIMANN, T ;
JANOWITZ, HD ;
AUFSES, AH .
GUT, 1988, 29 (05) :588-592
[10]   Triamcinolone improves outcome in Crohn's disease strictures [J].
Lavy, A .
DISEASES OF THE COLON & RECTUM, 1997, 40 (02) :184-186