Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn's disease strictures

Ashish Atreja, Ashish Aggarwal, Saurabh Dwivedi, Florian Rieder, Rocio Lopez, Bret A Lashner, Aaron Brzezinski, John J Vargo, Bo Shen
Journal of Crohn's & Colitis 2014, 8 (5): 392-400

BACKGROUND: Literature on endoscopic dilation of Crohn's disease (CD) strictures, especially for primary (non-anastomotic) strictures is limited.

METHODS: A historical cohort study was performed on patients who underwent endoscopic stricture dilations for CD in our IBD center. Primary endpoint was the efficacy of first endoscopic dilation in preventing the need for surgery in primary strictures compared to anastomotic strictures. Cox proportional hazards models using robust sandwich covariance matrix estimate were used to evaluate the need for surgery and any further endoscopic intervention.

RESULTS: In our study cohort (mean age 42.2 ± 13.1 years, 57% females, 16.4% current smokers, and median follow-up 1.8 years), 128 patients underwent a total of 430 endoscopic stricture dilations for 169 strictures (88 primary, 81 secondary). Forty-two patients (32.8%) required surgery in the follow-up period, with a mean interval period between first dilation and surgery of 33 months. There was no difference between primary or anastomotic strictures with respect to the need for surgery (34.1% vs. 29.6%, p=0.53), redilation (59.1% vs. 58%, p=0.89) or total interventions (surgery+redilations, 71.6% vs. 72.8%, p=0.86). Multivariable analysis did not show any significant difference between patients who received and did not receive intralesional steroid injections, biologics or immunomodulators with respect to the need for repeat intervention or surgery.

CONCLUSION: Efficacy and safety of endoscopic dilation are similar between primary and anastomotic CD strictures. Intralesional steroid injection or use of biologics did not decrease the need for re-intervention or surgery for either primary or anastomotic strictures.

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