Original article
Alimentary tract
Efficacy of Endoscopic Dilation of Gastroduodenal Crohn’s Disease Strictures: A Systematic Review and Meta-Analysis of Individual Patient Data

https://doi.org/10.1016/j.cgh.2018.11.048Get rights and content
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open access

Background & Aims

Little is known about the effects of endoscopic balloon dilation (EBD) for strictures of the upper gastrointestinal (UGI) tract in patients with Crohn’s disease (CD). We performed a pooled analysis of the efficacy and safety of EBD for UGI CD-associated strictures.

Methods

We searched Embase, Medline, and the Cochrane library, as well as bibliographies of relevant articles, for cohort studies of adults with CD and strictures of the stomach or duodenum (up to the ligament of Treitz) who underwent EBD through December 2016. We obtained data from 7 international referral centers on 94 patients who underwent 141 EBDs. We performed a patient-level meta-analysis of data from published and unpublished cohort studies to determine mechanical and clinical success. We performed a time-to-event analysis to assess symptom recurrence and need for redilation or surgery. The patients analyzed had strictures of the duodenum (n = 107), stomach (n = 30), or spanning both (n = 4).

Results

The rate of technical success for EBD was 100%, with 87% short-term clinical efficacy; major complications arose from 2.9% of all procedures. During a median follow-up period of 23.1 months, 70.5% of patients had a recurrence of symptoms, 59.6% required redilation, and 30.8% required surgical intervention. Patients whose disease was located in the small bowel had a higher risk for symptom recurrence (hazard ratio [HR], 2.1; P = .003). Asian race (HR, 2.8; P < .001) and location of disease in the small bowel (HR, 1.9; P = .004) increased the need for redilation. Prestenotic dilation was a risk factor for needing surgery earlier (HR, 1.9; P = .001).

Conclusions

In a meta-analysis, we found EBD for CD-associated strictures of the UGI to be an effective alternative to surgery, with a high rate of short-term technical and clinical success, moderate long-term efficacy, and an acceptable rate of complications.

Keywords

Therapy
Fibrosis
Stenosis
IBD
Endoscopy

Abbreviations used in this paper

CD
Crohn’s disease
EBD
endoscopic balloon dilatation
GI
gastrointestinal
HR
hazard ratio
TNF
tumor necrosis factor

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Conflicts of interest The authors disclose no conflicts.

Funding This work was supported by grants from the National Institutes of Health [T32DK083251, P30DK097948 Pilot, K08DK110415] to F.R.