Outcomes of Endoscopic Balloon Dilation vs Surgical Resection for Primary Ileocolic Strictures in Patients with Crohn’s Disease.
Clin Gastroenterol Hepatol. 2018 Mar 02;:
Authors: Lan N, Stocchi L, Ashburn JH, Hull TL, Steele SR, Delaney CP, Shen B
BACKGROUND & AIMS: Few studies have compared endoscopic balloon dilation (EBD) with ileocolic resection (ICR) in the treatment of primary ileocolic strictures in patients with Crohn’s disease (CD).
METHODS: We performed a retrospective study to compare post-procedure morbidity and surgery-free survival among 258 patients with primary stricturing ileo (colic) CD (B2, L1, or L3) initially treated with primary EBD (n=117) or ICR (n=258) from 2000 through 2016. Patients with penetrating disease were excluded from the study. We performed multivariate analyses to evaluate factors associated with surgery-free survival.
RESULTS: Post-procedural complications occurred in 4.7% of patients treated with EBD and salvage surgery was required in 44.4% of patients. Factors associated with reduced surgery-free survival among patients who underwent EBD included increased stricture length (hazard ratio [HR], 2.0; 95% CI, 1.3-3.3), ileocolonic vs. ileal disease (HR, 10.9; 95% CI, 2.6-45.4), and decreased interval between EBD procedures (HR, 1.2; 95% CI, 1.1-1.4). There were no significant differences in sex, age, race, or CD duration between EBD and ICR groups. Patients treated with ICR were associated with more common post-operative adverse events (32.2%, P<.0001), but reduced need for secondary surgery (21.7%, P<.0001) and significantly longer surgery-free survival (11.1±0.6 years vs. 5.4±0.6 years, P<.001).
CONCLUSION: In this retrospective study, we found that although EBD is initially successful with minimal adverse events, there is a high frequency of salvage surgery. Initial ICR is associated with a higher morbidity but a longer surgery-free interval. The risks and benefits should be balanced in selecting treatments for individual patients.
PMID: 29505909 [PubMed – as supplied by publisher]