Balloon Dilation of Ileocolonic Strictures in Crohn’s Disease

Objectives

Crohn’s disease is characterized by chronic, recurrent, transmural inflammation, which as a consequence of partial healing and localized fibrosis may lead to intestinal stricture formation (see Figure [1 a]). Following resectional surgery, recurrence of Crohn’s disease at the anastomosis or in the neo-terminal ileum may lead to stenosis. Treatment options for ileocolonic strictures include:

Figure 1 Endoscopic view of a Crohn’s stricture at an ileocolonic anastomosis: a before dilation; b ”through the balloon” view during dilation; c after dilation.

surgery (resection or stricturoplasty), anti-inflammatory medical therapy, and endoscopic balloon dilation.

Balloon dilation is an attractive first-line therapy as it is a minimally invasive approach which preserves intestinal length and function. Challenges for the endoscopist include:

appropriate selection of cases for dilation, achieving endoscopic access, successful passage of the balloon catheter through the endoscope and across the stricture, and obtaining adequate dilatation while minimizing the risk of major complications.

References

• 1 Breysem Y, Janssens J, Coremans G. et al . Endoscopic balloon dilation of colonic and ileo-colonic Crohn’s strictures: long-term results.  Gastrointest Endosc. 1992;  38 142-147
• 2 Van Assche G, Geboes K, Rutgeerts P. Medical therapy for Crohn’s disease strictures.  Inflamm Bowel Dis. 2004;  10 55-60
• 3 Couckuyt H, Gevers A, Coremans G. et al . Efficacy and safety of hydrostatic balloon dilatation of ieocolonic Crohn’s strictures: a prospective longterm analysis.  Gut. 1995;  36 577-580
• 4 Brooker J, Beckett C, Saunders B. et al . Long-acting steroid injection after endoscopic dilation of anastomotic Crohn’s strictures may improve the outcome: a retrospective case series.  Endoscopy. 2003;  35 333-337
• 5 Blomberg B, Rolny P, Järnerot G. Endoscopic treatment of anastomotic strictures in Crohn’s disease.  Endoscopy. 1991;  23 195-198
• 6 Dear K, Hunter J. Colonoscopic hydrostatic balloon dilatation of Crohn’s strictures.  J Clin Gastroenterol. 2001;  33 315-318
• 7 Thomas-Gibson S, Brooker J, Hayward C. et al . Colonoscopic balloon dilation of Crohn’s strictures: a review of long-term outcomes.  Eur J Gastroenterol Hepatol. 2003;  15 485-488
• 8 Sabaté J, Villarejo J, Bouhnik Y. et al . Hydrostatic balloon dilatation of Crohn’s strictures.  Aliment Pharmacol Ther. 2003;  18 409-413