Balloon-assisted enteroscopy has good short-term efficacy for Crohn’s strictures
Dilating small intestinal Crohn’s disease strictures with balloon-assisted enteroscopy had good short-term technical and clinical efficacy, according to a meta-analysis published in Alimentary Pharmacology & Therapeutics.
Dominik Bettenworth, MD, of University Hospital of Münster in Germany, and colleagues wrote that endoscopic balloon dilation (EBD) has become an important tool for the treatment of CD strictures.
“EBD of CD strictures is part of current guideline recommendations for the treatment of ileal strictures,” they wrote. “However, most studies evaluated EBD for terminal ileal and ileocolic anastomotic strictures which can be reached by standard ileocolonoscopy, and the evidence for EBD of small bowel strictures which can only be reached by [balloon-assisted enteroscopy (BAE)] is scarce.”
Researchers analyzed data from 18 studies comprising 463 patients who underwent 1,189 BAE procedures. They defined technical success as the ability to dilate a stricture. They also assessed data from 218 individual patients to identify outcome-relevant risk factors.
In their pooled, per-study analysis, investigators found that the technical success of EBD was 94.9%, and 82.3% of patients achieved at least short-term clinical success. However, 5.3% of patients experienced major complications.
During follow-up, nearly half of patients reported symptoms recurrence (48.3%), 38.8% had to undergo re-dilation, and 27.4% went on to surgery.
In their per-patient-based analysis, Bettenworth and colleagues found that patients with disease activity in the small intestine had lower odds of achieving short-term efficacy (OR = 0.32; 95% CI, 0.14-0.73). Additionally, they determined that patients with concomitant active disease in the small (HR = 1.85; 95% CI, 1.09-3.13) or large intestine (HR = 1.77; 95% CI, 1.34-2.34) had an increased risk for proceeding to surgery.
“Considering the acceptable complication rate, EBD of small bowel strictures using BAE is a valuable adjunct and alternative to surgery in selected patients,” Bettenworth and colleagues wrote. “However, up to two-thirds of patients might need re-dilation or surgery in the mid-term.”