Efficacy of Endoscopic Dilation of gastroduodenal Crohn’s disease strictures: A Systematic Review and Meta-analysis of Individual Patient Data.
Clin Gastroenterol Hepatol. 2018 Nov 29;:
Authors: Bettenworth D, Mücke MM, Lopez R, Singh A, Zhu W, Guo F, Matsui T, James TW, Herfarth H, Goetz M, Mao R, Kurada S, Hampe J, Matthes K, Karstensen JG, Valli PV, Duijvestein M, D’Haens G, Jairath V, Qiu TB, Ding NS, Rogler G, Rieder F
BACKGROUND & AIMS: Little is know about the effects of endoscopic balloon dilation (EBD) for strictures of the upper gastrointestinal (UGI) tract in patients with Crohn’s disease (CD). We performed a pooled analysis of the efficacy and safety of EBD for UGI CD-associated strictures.
METHODS: We searched the EMBASE, Medline and Cochrane library, as well as bibliographies of relevant articles, for cohort studies of adults with CD and strictures of the stomach, or duodenum (up to the ligament of Treitz) who underwent EBD through December 2016. We obtained data from 7 international referral centers on 94 patients who underwent 141 EBD. We performed a patient-level meta-analysis of data from published and unpublished cohort studies to determine mechanical and clinical success. We performed time to event analysis to assess symptom recurrence and need for re-dilation or surgery. The patients analyzed had strictures of the duodenum (n=107), stomach (n=30), or spanning both (n=4).
RESULTS: The rate of technical success for EBD was 100%, with 87% short term clinical efficacy; major complications arose from 2.9% of all procedures. During median follow up of 23.1 months, 70.5% patients had recurrence of symptoms, 59.6% required re-dilation, and 30.8% required surgical intervention. Patients whose disease was located in the small bowel had a higher risk for symptom recurrence (hazard ratio [HR], 2.1; P=.003). Asian race (HR, 2.8; P<.001) and location of disease in the small bowel (HR, 1.9; P=.004) increased the need for re-dilation. Prestenotic dilation was a risk factor for earlier need for surgery (HR, 1.9; P=.001).
CONCLUSIONS: In a meta-analysis, we found EBD for CD-associated strictures of the UGI to be a effective alternative to surgery, with a high rate of short-term technical and clinical success, moderate long-term efficacy, and an acceptable rate of complications.
PMID: 30503966 [PubMed – as supplied by publisher]