Endoscopic balloon dilation of ileal pouch strictures.
BACKGROUND
Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in patients with ulcerative colitis. Strictures can occur at the inlet and outlet of the pouch. Endoscopic balloon dilation has been successfully used in patients with Crohn's strictures at the small intestine and colon. There are no published trials on endoscopic balloon therapy of ileal pouch strictures.


OBJECTIVE
To evaluate outpatient endoscopic balloon dilation of strictures in ileal pouches.


METHODS
Patients underwent nonfluoroscopy-guided, nonsedated, outpatient endoscopic dilations with an 8.6-mm upper endoscope and through-the-scope balloons (size: 11-18 mm). Pre- and posttreatment Pouchitis Disease Activity Index symptom scores (range: 0-6), endoscopic stricture scores based on resistance in passing the endoscope (range: 0-4), and Cleveland Global Quality of Life were compared.


RESULTS
Nineteen patients with pouch strictures who had concurrent Crohn's disease of the pouch (n = 11), cuffitis (n = 5), and pouchitis (n = 3), including 14 inlet and 14 outlet strictures, were enrolled. The mean number of strictures for each patient was 1.61 +/- 0.78. All strictures were successfully dilated with the through-the-scope balloon, with a mean of 1.74 +/- 1.19 (range: 1-5) sessions for each patient. Nine patients had a second endoscopy at 8 wk and five patients had a third pouch endoscopy at 16 wk after the initial endoscopic dilation. Endoscopic stricture scores immediately (0.30 +/- 0.47), 8 wk (0.40 +/- 0.51), and 16 wk (0.44 +/- 0.76) after the dilation were significantly improved compared to the predilation stricture scores (2.67 +/- 0.78). The symptom scores and quality-of-life (QOL) scores improved at week 8 and 16 following dilation, with a mean follow-up of 6.10 +/- 5.83 months (2-25 months). No complications were experienced with the procedure. One patient with CD who failed endoscopic and medical therapy underwent pouch resection.


CONCLUSIONS
In conjunction with medical therapy, outpatient endoscopic balloon dilation appears safe and effective in treating pouch inlet and outlet strictures, by relieving symptoms, restoring pouch patency, and improving QOL in the majority of patients.
Shen
Bo
B
Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Fazio
Victor W
VW
Remzi
Feza H
FH
Delaney
Conor P
CP
Achkar
Jean-Paul
JP
Bennett
Anna
A
Khandwala
Farah
F
Brzezinski
Aaron
A
Doumit
Jhony
J
Liu
Wendy
W
Lashner
Bret A
BA
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002404:Catheterization / Q000379:methods*; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000601:surgery*; D003251:Constriction, Pathologic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D019449:Pouchitis / Q000209:etiology / Q000473:pathology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D016896:Treatment Outcome