Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video).
BACKGROUND
Crohn's disease (CD)-related small-bowel strictures remain a major cause of morbidity, frequently requiring surgery.


OBJECTIVE
Assessment of the feasibility and effectiveness of CD small-bowel stricture dilation by DBE.


METHODS
Prospective case series.


METHODS
Single, tertiary referral center.


METHODS
Outcome data on cases of DBE-assisted CD small-bowel stricture dilation were prospectively collected from 2005. Dilation was performed by using controlled radial expansion balloon dilators. A 10-cm visual analogue scale (VAS) was used to assess obstructive symptoms and dietary restriction before DBE stricture dilation and at follow-up.


RESULTS
A total of 13 DBEs were performed in 11 consecutive patients (mean +/- SD age 46.4 +/- 7.8 years). Eighteen small-bowel stricture dilations were performed in 9 of 11 patients. The mean dilation diameter was 15.4 mm (range 12-20 mm). In 2 cases, stricture dilation was not performed because adhesions made reaching the strictures impossible. One case was complicated by a delayed perforation. In the other 8 patients, stricture dilation was successful; VAS scores improved dramatically and none of the patients has required surgery (mean follow-up 20.5 months; range 2-41 months). During follow-up, 2 patients required repeated dilation (at 6.5 and 13 months, respectively) because of symptom recurrence. Clinical improvements in before and after VAS scores were significant (mean 8.8 vs 1.8, respectively; P < .001).


CONCLUSIONS
Small case series; single tertiary referral center.


CONCLUSIONS
DBE-assisted small-bowel stricture dilation for selected patients with CD is potentially of significant benefit and should be considered as a useful and effective alternative to surgery. Larger studies are required to confirm this benefit.
Despott
Edward J
EJ
The Wolfson Unit for Endoscopy, St. Mark's Hospital and Academic Institute, London, England.
Gupta
Arun
A
Burling
David
D
Tripoli
Eric
E
Konieczko
Krysia
K
Hart
Ailsa
A
Fraser
Chris
C
D000328:Adult; D002404:Catheterization / Q000295:instrumentation*; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014741:Video Recording