Long-Term Outcomes of Endoscopic Balloon Dilation for Benign Strictures in Patients with Inflammatory Bowel Disease
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Background/Aims: Benign intestinal strictures are common complications in patients with inflammatory bowel disease (IBD). This study aimed to assess the long-term prognosis of endoscopic balloon dilation (EBD) to treat benign strictures in IBD patients. Methods: Patients with IBD who had benign strictures and who underwent EBD in four tertiary referral university hospitals between January 2004 and February 2014 were retrospectively reviewed. Technical success was defined as the ability to pass the scope through the stricture after balloon dilation, and clinical success was defined as improved obstructive symptoms. Results: Forty-two benign strictures were identified in 30 patients (15 males and 15 females). Technical success was achieved in 26 patients (86.7%) at the first EBD attempt and in all 30 patients (100%) at the second EBD attempt. Clinical success was seen in 28 patients (93.3%). The median follow-up duration was 134.8 months (range, 10.2 to 252.0 months), and recurrence occurred in eight patients (26.7%), who required repeat EBD. The median duration to relapse was 1.7 months (range, 0.2 to 6.3 months). During repeat EBD, perforation occurred in two cases (6.7%), which were both clipped successfully. Finally, only one patient (3.3%) underwent surgery for the relief of recurrent obstructive symptoms during the follow-up period. Conclusions: The experience of 10 years shows that EBD is safe and effective for the treatment of benign strictures in IBD patients. Importantly, EBD may allow long-term effective palliation of the symptoms associated with benign intestinal strictures in IBD patients.
Abstract
Background/Aims: Benign intestinal strictures are common complications in patients with inflammatory bowel disease (IBD). This study aimed to assess the long-term prognosis of endoscopic balloon dilation (EBD) to treat benign strictures in IBD patients. Methods: Patients with IBD who had benign strictures and who underwent EBD in four tertiary referral university hospitals between January 2004 and February 2014 were retrospectively reviewed. Technical success was defined as the ability to pass the scope through the stricture after balloon dilation, and clinical success was defined as improved obstructive symptoms. Results: Forty-two benign strictures were identified in 30 patients (15 males and 15 females). Technical success was achieved in 26 patients (86.7%) at the first EBD attempt and in all 30 patients (100%) at the second EBD attempt. Clinical success was seen in 28 patients (93.3%). The median follow-up duration was 134.8 months (range, 10.2 to 252.0 months), and recurrence occurred in eight patients (26.7%), who required repeat EBD. The median duration to relapse was 1.7 months (range, 0.2 to 6.3 months). During repeat EBD, perforation occurred in two cases (6.7%), which were both clipped successfully. Finally, only one patient (3.3%) underwent surgery for the relief of recurrent obstructive symptoms during the follow-up period. Conclusions: The experience of 10 years shows that EBD is safe and effective for the treatment of benign strictures in IBD patients. Importantly, EBD may allow long-term effective palliation of the symptoms associated with benign intestinal strictures in IBD patients.
참고문헌 (36)
- Ferlitsch A, "Safety and efficacy of endoscopic balloon dilation for treatment of Crohn's disease strictures", Endoscopy, 38, pp.483~487 (2006)[DOI]
- 박찬혁, "Clinical Efficacy of Endoscopic Treatment for Benign Colorectal Stricture: Balloon Dilatation versus Stenting", Gut and Liver, 9(1), pp.73~79 (2015), 거트앤리버 소화기연관학회협의회
- Nielsen OH, "New strategies for treatment of inflammatory bowel disease", Front Med (Lausanne), 1, pp.3~ (2014)
- Sokol H, "Complications and surgery in the inflammatory bowel diseases biological era", Curr Opin Gastroenterol, 30, pp.378~384 (2014)[DOI]
- Alexander-Williams J, "Conservative operations for Crohn's disease of the small bowel", World J Surg, 9, pp.945~951 (1985)[DOI]
- Lee EC, "Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease", Ann R Coll Surg Engl, 64, pp.229~233 (1982)
- Wolters FL, "Systematic review: has disease outcome in Crohn's disease changed during the last four decades?", Aliment Pharmacol Ther, 20, pp.483~496 (2004)[DOI]
- Legnani PE, "Therapeutic options in the management of strictures in Crohn's disease", Gastrointest Endosc Clin N Am, 12, pp.589~603 (2002)[DOI]
- Blomberg B, "Endoscopic treatment of anastomotic strictures in Crohn's disease", Endoscopy, 23, pp.195~198 (1991)[DOI]
- Paine E, "Endoscopic therapy in inflammatory bowel diseases (with videos)", Gastrointest Endosc, 78, pp.819~835 (2013)[DOI]
- Hassan C, "Systematic review: endoscopic dilatation in Crohn's disease", Aliment Pharmacol Ther, 26, pp.1457~1464 (2007)[DOI]
- Stienecker K, "Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn's disease: a prospective study", World J Gastroenterol, 15, pp.2623~2627 (2009)[DOI]
- Vrabie R, "Endoscopic management of inflammatory bowel disease strictures", World J Gastrointest Endosc, 4, pp.500~505 (2012)[DOI]
- Endo K, "Short and long-term outcomes of endoscopic balloon dilatation for Crohn's disease strictures", World J Gastroenterol, 19, pp.86~91 (2013)[DOI]
- de'Angelis N, "Short- and long-term efficacy of endoscopic balloon dilation in Crohn's disease strictures", World J Gastroenterol, 19, pp.2660~2667 (2013)[DOI]
- Thomas-Gibson S, "Colonoscopic balloon dilation of Crohn's strictures: a review of long-term outcomes", Eur J Gastroenterol Hepatol, 15, pp.485~488 (2003)
- Breysem Y, "Endoscopic balloon dilation of colonic and ileocolonic Crohn's strictures: long-term results", Gastrointest Endosc, 38, pp.142~147 (1992)[DOI]
- Scimeca D, "Efficacy and safety of endoscopic balloon dilation of symptomatic intestinal Crohn's disease strictures", Dig Liver Dis, 43, pp.121~125 (2011)[DOI]
- Morar PS, "Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures", Aliment Pharmacol Ther, 42, pp.1137~1148 (2015)[DOI]
- Louis E, "Behaviour of Crohn's disease according to the Vienna classification: changing pattern over the course of the disease", Gut, 49, pp.777~782 (2001)[DOI]
- Oberhuber G, "Significant association of strictures and internal fistula formation in Crohn's disease", Virchows Arch, 437, pp.293~297 (2000)[DOI]
- Gumaste V, "Benign and malignant colorectal strictures in ulcerative colitis", Gut, 33, pp.938~941 (1992)[DOI]
- Wolters FL, "Disease outcome of inflammatory bowel disease patients: general outline of a Europewide population-based 10-year clinical follow-up study", Scand J Gastroenterol Suppl, (243), pp.46~54 (2006)
- Krauss E, "Long term follow up of through-the-scope balloon dilation as compared to strictureplasty and bowel resection of intestinal strictures in crohn's disease", Int J Clin Exp Pathol, 7, pp.7419~7431 (2014)
- Wibmer AG, "Comparison of strictureplasty and endoscopic balloon dilatation for stricturing Crohn's disease: review of the literature", Int J Colorectal Dis, 25, pp.1149~1157 (2010)[DOI]
- De Cruz P, "Crohn's disease management after intestinal resection: a randomised trial", Lancet, 385, pp.1406~1417 (2015)[DOI]
- Atreja A, "Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn's disease strictures", J Crohns Colitis, 8, pp.392~400 (2014)[DOI]
- Couckuyt H, "Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn's strictures: a prospective longterm analysis", Gut, 36, pp.577~580 (1995)[DOI]
- Ramboer C, "Endoscopic treatment of stenosis in recurrent Crohn's disease with balloon dilation combined with local corticosteroid injection", Gastrointest Endosc, 42, pp.252~255 (1995)[DOI]
- Brooker JC, "Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: a retrospective case series", Endoscopy, 35, pp.333~337 (2003)[DOI]
- Di Nardo G, "Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn's disease with stricture: a prospective, randomized, double-blind, controlled trial", Gastrointest Endosc, 72, pp.1201~1208 (2010)[DOI]
- East JE, "A pilot study of intrastricture steroid versus placebo injection after balloon dilatation of Crohn's strictures", Clin Gastroenterol Hepatol, 5, pp.1065~1069 (2007)[DOI]
- Condino G, "Anti-TNF-alpha treatments and obstructive symptoms in Crohn's disease: a prospective study", Dig Liver Dis, 45, pp.258~262 (2013)[DOI]
- Thienpont C, "Endoscopic and medical management of fibrostenotic Crohn's disease", Dig Dis, 32(Suppl 1), pp.35~38 (2014)[DOI]
- Chen-Wang Chang, "Intestinal Stricture in Crohn’s Disease", Intestinal research, 13(1), pp.19~26 (2015), 대한장연구학회[DOI]
- Ono Y, "Value of concomitant endoscopic balloon dilation for intestinal stricture during long-term infliximab therapy in patients with Crohn's disease", Dig Endosc, 24, pp.432~438 (2012)[DOI]