Endoscopic balloon dilatation of Crohn's strictures: a safe method to defer surgery in selective cases

<jats:sec><jats:title>Background</jats:title><jats:p>Endoscopic balloon dilatation (<jats:styled-content style="fixed-case">EBD</jats:styled-content>) provides a valuable alternative to surgery for strictures in Crohn's disease (<jats:styled-content style="fixed-case">CD</jats:styled-content>). Data are lacking regarding the factors that improve the safety and effectiveness of <jats:styled-content style="fixed-case">EBD</jats:styled-content> in <jats:styled-content style="fixed-case">CD</jats:styled-content>. The aim of this study is to determine the safety and efficacy of <jats:styled-content style="fixed-case">EBD</jats:styled-content> and the clinical variables, which are predictive of successful treatment of <jats:styled-content style="fixed-case">CD</jats:styled-content> strictures with <jats:styled-content style="fixed-case">EBD</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The records of all patients with <jats:styled-content style="fixed-case">CD</jats:styled-content> in whom <jats:styled-content style="fixed-case">EBD</jats:styled-content> was attempted between 2008 and 2013 were reviewed. Procedures were conducted at a single tertiary referral centre using a Boston Scientific <jats:styled-content style="fixed-case">CRE</jats:styled-content>® <jats:styled-content style="fixed-case">TTS</jats:styled-content> balloon. Technical success was defined as the ability to traverse the stricture with the endoscope and clinical success as the resolution of obstructive symptoms at review.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Forty‐seven patients with a total of 58 strictures (19 primary and 39 anastomotic strictures) were treated with <jats:styled-content style="fixed-case">EBD</jats:styled-content> with median follow‐up of 37 months. A total of 161 dilatation procedures were performed, with technical success reported in 139/158 (88%) cases and clinical success reported in 105/137 (76.7%) cases with complete data. Complications occurred in 7/161 dilatations (4.3% dilatations, 15% patients), three patients with perforation, one with acute bleeding and three admitted with abdominal pain. Eighteen of the 47 patients required surgery (38%). Strictures of <50 mm (<jats:italic>P</jats:italic> = 0.04) and those dilated to a diameter of ≥15 mm (<jats:italic>P</jats:italic> = 0.031) were less likely to require surgical resection.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> <jats:styled-content style="fixed-case">EBD</jats:styled-content> is safe for both primary and post‐surgical strictures. Stricture length and diameter of dilatation are predictive of success. In selected patients, treatment with <jats:styled-content style="fixed-case">EBD</jats:styled-content> may reduce or delay the need for surgery.</jats:p></jats:sec>