Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: a retrospective case series.
OBJECTIVE
Endoscopic balloon dilation of Crohn's strictures is widely practised, but may not result in long-term symptomatic benefit, leading to the need for repeat dilation or surgery. It is hypothesized that long-acting steroid injection into strictures after dilation may decrease the need for further stricture dilation and improve the outcome in symptomatic patients.


METHODS
Patients with Crohn's disease who have had balloon dilation and triamcinolone injection performed for symptomatic anastomotic strictures were identified from endoscopy records. Case notes were reviewed to determine outcomes.


RESULTS
Fourteen patients underwent a total of 26 dilations, with triamcinolone injected (median dose 20 mg, 10-40 mg) in 20 of the procedures. Seven patients (50%) had sustained remission after a single dilation and steroid injection, with a median follow-up period of 16.4 months (range 13.2-22.0 months). Four patients (28.5%) required more than one dilation (median three dilations, range two to four) to control their symptoms, with a median follow-up period of 27.8 months (range 14-32.8 months). Endoscopic management failed in three patients (21.4 %), who were referred for surgery. There were no complications due to dilation or triamcinolone injection.


CONCLUSIONS
Triamcinolone injection into the stricture after dilation is safe, easy to perform, and may be a useful adjunct in the management of anastomotic Crohn's strictures. These data will require further support through a randomized and controlled trial.
Brooker
J C
JC
Wolfson Unit for Endoscopy, St. Mark's Hospital, London, United Kingdom. j.brooker@ic.ac.uk
Beckett
C G
CG
Saunders
B P
BP
Benson
M J
MJ
D000368:Aged; D000714:Anastomosis, Surgical; D002404:Catheterization; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use*
D005938:Glucocorticoids; D014221:Triamcinolone