Balloon Delivery Difficulties during Endoscopic Balloon Dilation for Crohn's Disease-Associated Strictures

Endoscopic balloon dilation (EBD) is an established and effective treatment for gastrointestinal strictures associated with Crohn's disease (CD). However, technical complications related to balloon delivery have not been systematically evaluated. This study aimed to assess the incidence, characteristics, and risk factors associated with balloon delivery difficulties (BDDs) during EBD.

This retrospective, single-center study analyzed EBD sessions performed for gastrointestinal strictures associated with CD. Each EBD session was considered the unit of analysis. BDD was defined as difficulty in balloon withdrawal, balloon insertion, or balloon damage. The session-based incidence of BDD and associated factors were evaluated.

A total of 319 EBD sessions were included. BDD occurred in 33 sessions (10.3%). The types of BDD included difficulty in balloon withdrawal (11 events), difficulty in balloon insertion (24 events), and balloon damage (6 events). Six BDD events occurred during the first EBD attempt within a session, whereas 27 events occurred during the second and subsequent attempts. Difficulty in balloon insertion predominantly occurred during repeated EBD attempts. A higher number of EBD attempts within the same session (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.07-6.80; p = 0.025) and a smaller working channel diameter (OR, 3.13; 95% CI, 1.28-7.69; p = 0.009) were associated with BDD.

BDD occurred in approximately 10% of EBD sessions and was more likely to develop during repeated dilation attempts within the same session. These findings may help inform endoscopists about procedural risk and optimize dilation strategies during EBD.