Long-term outcome of endoscopic pneumatic dilatation in Crohn's disease.
BACKGROUND
To avoid multiple surgeries in stenosing Crohn's disease, pneumatic endoscopic dilatation has been introduced. The present study evaluated the long-term clinical outcome in Crohn's disease patients after endoscopic dilatation for ileal or neoileal strictures.


METHODS
All Crohn's disease patients who underwent pneumatic dilatation of ileal or ileo-colonic strictures between January 1988 and December 2001 were invited to return for a clinical check-up in June 2002. Clinical, endoscopic and radiological reports were reviewed. Symptomatic relief from sub-occlusive symptoms without requiring surgery was considered as a positive outcome, whereas the requirement of surgery was regarded as an unfavourable outcome. Possible predictors of favourable outcome were analysed.


RESULTS
Endoscopic dilatation was technically successful in 34/43 (79%) Crohn's disease patients, with a mean number of dilatations per patient of 3 +/- 3.13. During a mean follow-up of 63.7 +/- 44.6 months, a positive long-term outcome was observed in 18 (52.9%) patients, whereas surgery was necessary in the remaining 16 cases. The risk of surgery was distinctly higher within 2 years post-dilatation than in the next 2 years (26.4% versus 8.3%, respectively; P = 0.078). No clear clinical, endoscopic or radiological predictive factors for a successful outcome were identified.


CONCLUSIONS
Endoscopic pneumatic dilatation is an effective and safe procedure to be applied to patients with stenosing Crohn's disease, offering a very long-term benefit in a sub-group of patients.
Morini
S
S
Department of Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy. gastroroma@virgilio.it
Hassan
C
C
Lorenzetti
R
R
Zullo
A
A
Cerro
P
P
Winn
S
S
Giustini
M
M
Taggi
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002404:Catheterization; D003106:Colon / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D003424:Crohn Disease / Q000453:epidemiology / Q000628:therapy*; D018572:Disease-Free Survival; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D005676:Gravity Suits; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery; D007558:Italy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012307:Risk Factors; D013995:Time; D016896:Treatment Outcome