title: Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease.
abstract: BACKGROUND
  Bowel strictures are a major cause of morbidity, hospitalisation and surgery in Crohn's disease.
  
  
  OBJECTIVE
  We report short- and long-term efficacy and safety of endoscopic balloon dilation of strictures due to Crohn's disease.
  
  
  METHODS
  Retrospective study of patients who underwent endoscopic balloon dilation between 1987 and 2009.
  
  
  RESULTS
  We performed 776 dilations, of which 621 (80%) were on anastomotic strictures, in 178 patients (94 women) with Crohn's disease. At first dilation, median (IQR) age of patients was 45 (37-56) years and disease duration 16 (8-22) years. Technical success rate was 689/776 (89%). A subset of 75 patients from the primary catchment area, with >5-year follow-up, underwent a total of 246 dilations. At 1-year follow-up, 60/75 (80%) patients had undergone no further intervention or one additional dilation only. At 3 and 5 years, corresponding figures were 43/75 (57%) and 39/75 (52%). Cumulative proportions of patients undergoing surgery at 1, 3 and 5 years were 13%, 28% and 36%. Complication rate per procedure for all 178 patients was 41/776 (5.3%), bowel perforation (n = 11, 1.4%), major bleeding requiring blood transfusion (n = 8, 1.0%), minor bleeding (n = 10, 1.3%) and abdominal pain or fever (n = 12, 1.5%). Ten patients underwent surgery due to complications (perforation n = 8, bleeding n = 2). There was no procedure-related mortality.
  
  
  CONCLUSIONS
  Endoscopic balloon dilation is an efficacious and safe alternative to surgical resection of intestinal strictures in Crohn's disease. At 5-year follow-up, 52% of patients required no further or one additional dilation only, whereas 36% had undergone surgical resection. Complication frequency was low.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Gustavsson
authors.forename: A
authors.initials: A
authors.lastname: Magnuson
authors.forename: B
authors.initials: B
authors.lastname: Blomberg
authors.forename: M
authors.initials: M
authors.lastname: Andersson
authors.forename: J
authors.initials: J
authors.lastname: Halfvarson
authors.forename: C
authors.initials: C
authors.lastname: Tysk
mesh_terms: D000328:Adult; D002404:Catheterization / Q000379:methods*; D003424:Crohn Disease / Q000150:complications / Q000628:therapy*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome