Outcomes of endoscopic balloon dilatation for de novo and anastomotic Crohn’s strictures: a Canadian tertiary center experience
Sudheer Kumar Vuyyuru, Gaurav Nigam, Shane W Goodwin, Shivya Sethi, Jamie Gregor, Brian Yan, Michael Sey, Vipul JairathAbstract
Background
Over half of patients with Crohn’s disease (CD) develop intestinal strictures that often require surgical resection. Endoscopic balloon dilatation (EBD) can be a potential alternative therapeutic option.
Methods
This retrospective cohort study included adult patients with CD (≥18 years) who underwent EBD between January 2016 and September 2024 at two Canadian hospitals. The primary outcome was technical success. Secondary outcomes were clinical success at 6 and 12 months, hospitalization due to obstruction, and CD-related surgery. Cox proportional hazards models assessed predictors of outcomes.
Results
A total of 234 patients (age: 47.6 years, males: 47.4%) were included with mean disease duration of 17.7 years and median follow-up of 61 months. A majority of the strictures (226/234) were dilated under ileocolonoscopy guidance, and 79.4% had symptoms at baseline. Most strictures were of de novo type (62.5%) and the median number of stricture dilatations was 3 (IQR: 2). Technical success was achieved in 81% (150/185). Clinical success was noted in 47.7% at 6 months. The cumulative probabilities of being hospitalization-free were 96.9% (95% CI 94.7-99.2]) at 1 year, 91.3% (95% CI 87.5-95.2) at 3 years, and 85.0% (95% CI 79.8-90.5) at 5 years. The cumulative probabilities of being surgery-free were 91.1% (95% CI 87.5-94.9) at 1 year, 81.7% (95% CI 76.5-87.2) at 3 years, and 78.1% (95% CI 72.4-84.3) at 5 years. Multiple strictures were associated with an increased risk of surgery while anastomotic strictures and maximum balloon diameter were associated with lower risk. No patients experienced procedure-related complications.
Conclusions
EBD is effective and safe in de novo and anastomotic strictures with the majority of patients achieving technical success and being free of surgery within 5 years.