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Endoscopic balloon dilation for management of stricturing Crohn's disease in children
Brianna McSorley1, Robert A Cina2, Candi Jump3
1Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States.
Insights
Endoscopic balloon dilation (EBD) is a safe and effective treatment for children with Crohn's disease (CD) strictures, offering an alternative to surgery. This approach successfully managed most strictures without complications.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Minimally Invasive Surgery
Background:
- Crohn's disease (CD) frequently causes intestinal strictures in children, often necessitating surgery.
- Surgical resection is the traditional treatment, but endoscopic balloon dilation (EBD) shows promise as an alternative.
- Limited evidence exists on EBD's safety and efficacy in pediatric patients with CD-related strictures.
Purpose of the Study:
- To compare the outcomes of endoscopic balloon dilation (EBD) versus surgery for treating fibrostenotic strictures in pediatric Crohn's disease patients.
- To assess the safety and efficacy of EBD as a primary or subsequent intervention for strictures in children with CD.
Main Methods:
- Retrospective single-center study of pediatric patients (0-18 years) diagnosed with CD and stricturing phenotype between July 2012 and May 2019.
- Identification of patients using diagnostic codes and interventions via procedural/surgical billing codes.
- Evaluation of demographics, clinical variables, and outcomes for patients undergoing EBD, surgery, or both.
Main Results:
- Of 139 CD patients, 25 developed strictures; 13 initially underwent EBD and 12 had surgery.
- 17 patients (68%) received EBD at some point; 4 patients initially treated with surgery later required EBD.
- EBD showed an 88% success rate in managing strictures without complications like perforation, with no further surgical intervention needed.
Conclusions:
- Endoscopic balloon dilation (EBD) is a safe and effective alternative to surgery for selected pediatric patients with Crohn's disease strictures.
- EBD offers a successful palliative management option, reducing the need for repeat surgical interventions.
- Further research into EBD for pediatric CD strictures is warranted to solidify its role in treatment algorithms.
Background:
Crohn's disease (CD) has a multitude of complications including intestinal strictures from fibrostenotic disease. Fibrostenotic disease has been reported in 10%-17% of children at presentation and leads to surgery in 20%-50% of cases within ten years of diagnosis. When symptoms develop from these strictures, the treatment in children has primarily been surgical resection. Endoscopic balloon dilation (EBD) has been shown to be a safe and efficacious alternative to surgery in adults, but evidence is poor in the literature regarding its safety and efficacy in children.
Aim:
To evaluate the outcomes of children with fibrostenosing CD who underwent EBD vs surgery as a treatment.
Methods:
In a single-center retrospective study, we looked at pediatric patients (ages 0-18) who carry the diagnosis of CD, who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1, 2012 through May 1, 2019. We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype. The type of intervention for patients' strictures was then identified through procedural and surgical billing codes. We evaluated their demographics, clinical variables, whether they underwent EBD vs surgery or both, and their clinical outcomes.
Results:
Of the 139 patients with CD, 25 (18%) developed strictures. The initial intervention for a stricture was surgical resection in 12 patients (48%) and EBD in 13 patients (52%). However, 4 (33%) patients whom initially had surgical resection required follow up EBD, and thus 17 total patients (68%) underwent EBD at some point in their treatment process. For those 8 patients who underwent successful surgical resection alone, 4 of these patients (50%) had a fistula present near the stricture site and 4 (50%) had strictures greater than 5 cm in length. All patients who underwent EBD had no procedural complications, such as a perforation. Twenty-two (88%) of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period.
Conclusion:
EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.
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