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Colonoscopic hydrostatic balloon dilatation of Crohn's strictures
1Department of Gastroenterology, Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom.
Insights
Endoscopic balloon dilatation offers a safe and effective treatment for Crohn's disease strictures, avoiding surgery in most patients. While some may need repeat procedures, complications are minimal.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
Background:
- Recurrent strictures are a significant cause of morbidity in Crohn's disease patients.
- Surgical intervention is often required for managing these strictures.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic hydrostatic balloon dilatation for Crohn's strictures.
- To compare outcomes of balloon dilatation with surgical intervention.
Main Methods:
- Retrospective review of patients undergoing endoscopic hydrostatic balloon dilatation for Crohn's strictures.
- Radiological assessment of strictures and treatment of active disease prior to dilatation.
- Dilatation performed using Microvasive Rigiflex balloons.
- Outcome assessment through clinical follow-up.
Main Results:
- 16 out of 22 patients (73%) experienced resolution of obstructive symptoms after dilatation.
- One-third of patients required more than two dilatations.
- 6 out of 22 patients (27%) ultimately required surgery due to persistent symptoms.
- No complications were reported across 71 dilatations.
Conclusions:
- Endoscopic hydrostatic balloon dilatation is a safe and effective alternative to surgery for Crohn's strictures within colonoscopic reach.
- It provides symptom relief and avoids surgery in a majority of patients.
- Careful patient selection and management of active disease are crucial for successful outcomes.
Abstract:
Recurrent strictures cause considerable morbidity among many patients with Crohn's disease. We present a retrospective review of the outcome of patients who underwent endoscopic hydrostatic balloon dilatation of Crohn's strictures in our hospital over the past 7 years. All patients were under observation at Addenbrooke's Hospital, Cambridge. An initial assessment of all strictures was made radiologically, and any patient with active disease was treated before consideration of endoscopic dilatation. Dilatation was carried out with Microvasive Rigiflex balloons. Outcome after dilatation was assessed by review at subsequent clinic visits. Sixteen of 22 patients had resolution of their obstructive symptoms after dilatation, although one third of patients required more than two dilatations over the follow-up period. Six of 22 patients had persisting symptoms after endoscopic treatment, requiring surgery. There were no complications noted after any of the 71 dilatations that were performed. We conclude that hydrostatic balloon dilatation is a safe and effective alternative to surgery in the management of Crohn's strictures within the reach of the colonoscope.