Long term follow up of through the endoscope balloon dilatation as compared to strictureplasty and bowel resection of intestinal strictures in crohn's disease

Background & aims: Ileo-colonic strictures are common complication of Crohn's disease (CD), and may result in repeated endoscopic or surgical therapy with a fear of further complications, such as perforation or short bowel syndrome. This study compares CD patients with endoscopic dilatation and surgical resection or strictureplasty of intestinal stenosis regarding long-term outcome, incorporating characteristic of stricture, influx of disease activity and medication.

Methods: In this study we included 88 CD patients (37 male, 51 female, mean age 40 years, range 19–65 years), who between Jan. 2002– Dec. 2009 undergone either surgical or endoscopical therapy. The primary end-point was length of stricture- and operation-free interval; the mean follow-up period was 5 years (3–7 years). The patients were initially randomized into four groups: only surgical therapy, only endoscopic therapy, endoscopy with following surgical therapy, and initial surgical therapy with following endoscopic dilatation.

Results: The patients, who undergone only surgical therapy had an average length of stenosis of 7cm (range 4–12,5cm) with operation-free time of 68,5 months and stenosis-free time of 67,5 months (p=0.044). Patients undergoing only endoscopic dilatation had an average length of stenosis 2–4cm in ileum (stenosis-free time 4,5–60 months), 1–2,5cm in cecum (4,5–11,75 months), 4–10cm in sigma (6–39 months), 1–2cm in rectum (1–12 months), p=0,139. The two other groups showed similar results. Statistically, we could not prove any relevant difference between numbers of stenosis (1, 2–3, >3), characteristic of stenosis (length, anastomosis or new stricture, mucosal inflammation etc) or medication in terms of stenosis- or operation-free time.

Conclusions: The long-term efficacy of endoscopic balloon dilatation as well as surgical resection depends on many factors. The optimal strategy after intervention has to be based on a patient's clinical risk factors with treatment then adjusted to clinical and endoscopic findings in the first post-interventional year.