Elsevier

Gastrointestinal Endoscopy

Volume 70, Issue 5, November 2009, Pages 1030-1036
Gastrointestinal Endoscopy

Case study
Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video)

https://doi.org/10.1016/j.gie.2009.05.005Get rights and content

Background

Crohn's disease (CD)–related small-bowel strictures remain a major cause of morbidity, frequently requiring surgery.

Objective

Assessment of the feasibility and effectiveness of CD small-bowel stricture dilation by DBE.

Design

Prospective case series.

Settings

Single, tertiary referral center.

Methods

Outcome data on cases of DBE-assisted CD small-bowel stricture dilation were prospectively collected from 2005. Dilation was performed by using controlled radial expansion balloon dilators. A 10-cm visual analogue scale (VAS) was used to assess obstructive symptoms and dietary restriction before DBE stricture dilation and at follow-up.

Results

A total of 13 DBEs were performed in 11 consecutive patients (mean ± SD age 46.4 ± 7.8 years). Eighteen small-bowel stricture dilations were performed in 9 of 11 patients. The mean dilation diameter was 15.4 mm (range 12-20 mm). In 2 cases, stricture dilation was not performed because adhesions made reaching the strictures impossible. One case was complicated by a delayed perforation. In the other 8 patients, stricture dilation was successful; VAS scores improved dramatically and none of the patients has required surgery (mean follow-up 20.5 months; range 2-41 months). During follow-up, 2 patients required repeated dilation (at 6.5 and 13 months, respectively) because of symptom recurrence. Clinical improvements in before and after VAS scores were significant (mean 8.8 vs 1.8, respectively; P < .001).

Limitations

Small case series; single tertiary referral center.

Conclusion

DBE-assisted small-bowel stricture dilation for selected patients with CD is potentially of significant benefit and should be considered as a useful and effective alternative to surgery. Larger studies are required to confirm this benefit.

Section snippets

Materials and methods

DBE was introduced to St. Mark's Hospital in February 2005. Data for patients with CD referred for small-bowel stricture dilation were prospectively collected. Almost all patients presented with obstructive-type symptoms: abdominal pain and bloating with chronic dietary restriction. The following information was recorded: stricture characteristics, route of procedure, dilation success, symptom resolution and change in diet post-dilation, need for repeated dilation, complications, and surgery. A

Results

Overall in the 13 DBE procedures that were performed during the study period (February 2005 to October 2008), 18 small-bowel stricture dilations were performed in 9 of 11 patients. The mean stricture dilation diameter was 15.4 mm (range 12-20 mm). In the 2 patients in whom stricture dilation was not performed, DBE proved to be technically challenging. Adhesions from previous surgery and possibly from underlying CD itself made it impossible to reach the strictures in these patients who

Discussion

Although endoscopic hydrostatic dilation of CD-associated strictures has been used since the late 1980s,18 the technique has been mainly applied to upper GI, ileocolic, or colonic strictures19, 20, 21 because most of the small bowel has remained inaccessible to conventional flexible endoscopy. The ability to reach and dilate strictures deep within the small-bowel endoscopically is now possible with DBE. Our case series adds to the currently small body of published evidence,16 which shows that

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    DISCLOSURE: The following author disclosed financial relationships relevant to this publication: E. Despott: research grant, Endoscopy UK/Fujinon. All other authors disclosed no financial relationships relevant to this publication.

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