Endoscopic treatment of stenosis in recurrent Crohn's disease with balloon dilation combined with local corticosteroid injection☆,☆☆

PATIENTS AND METHODS

Thirteen patients with Crohn's disease were treated by this technique and followed during a period of 9 to 73 months (mean, 47 months). At colonoscopy, all had active lesions and symptomatic stenosis that precluded passage of a standard colonoscope (13-mm diameter). All patients presenting with this problem during a 6-year period were included, except for a patient with severe infection. They represented about one-third of the population with Crohn's disease followed in our department during

RESULTS

Thirteen patients with Crohn's disease and lower gastrointestinal stenosis or stricture were treated by colonoscopic balloon dilation followed by local injection of corticosteroids in the dilated and inflamed area. Only 1 patient (No. 6) had no previous surgery; he had extensive ileal disease with strictures close to the ileocecal valve and symptoms of imminent intestinal obstruction. Without increasing the systemic medical treatment, he remained well by undergoing 7 sessions of combined

DISCUSSION

The purpose of starting this combined treatment about 6 years ago was to find out if dilation and local corticosteroid injection could prevent stenosis requiring surgical treatment. The additional benefit of the local corticosteroids was of particular interest.

Before undertaking to treat patients with Crohn's disease in this way, we had noticed that the need for frequent dilations in a patient with caustic stenosis of the esophagus (about monthly for at least 7 months) immediately stopped after