Outcomes of Endoscopic Balloon Dilation vs Surgical Resection for Primary Ileocolic Strictures in Patients with Crohn’s Disease.

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

Abstract
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]

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/29505909?dopt=Abstract