Value of concomitant endoscopic balloon dilation for intestinal stricture during long-term infliximab therapy in patients with Crohn's disease.
OBJECTIVE
We assessed the long-term outcome of infliximab (IFX) therapy in patients with Crohn's disease (CD) and investigated the efficacy of concomitant endoscopic balloon dilation (EBD) for intestinal stricture during treatment.


METHODS
The effectiveness of maintenance therapy with IFX was retrospectively evaluated in 185 patients with CD in a single center (median observation period 24 months). IFX effectiveness with and without immunomodulators (IMM) and enteral nutrition (EN), as well as cumulative surgery-free rates, were compared. The efficacy of concomitant EBD in patients with obstructive symptoms and high-level stricture was evaluated.


RESULTS
In 185 patients receiving the maintenance therapy, the long-term efficacy rate was 84.9% at 24 months and 79.0% at 48 months. The cumulative surgery-free rate was significantly higher in the maintenance group (P < 0.001). Concomitant IMM and EN did not significantly affect the effectiveness of IFX. IFX was discontinued in only 18 cases (7.3%). Symptomatic high-level stricture occurred in 33 patients (17.8%) in the maintenance group and the cumulative surgery-free rate was significantly higher in the EBD combination compared with the non-EBD group (P < 0.05). If EBD were considered invasive intervention, the actual cumulative surgery rate in the maintenance group was significantly lower compared with the cumulative invasive intervention rate (P < 0.001).


CONCLUSIONS
Long-term treatment with IFX is highly effective. The surgery-free rate was clearly higher in the maintenance group. Only concomitant EBD for intestinal stricture helped in the avoidance of surgery.
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan. yono6110@gmail.com
Yoichiro
Y
Ono
Fumihito
F
Hirai
Toshiyuki
T
Matsui
Takahiro
T
Beppu
Yutaka
Y
Yano
Noritaka
N
Takatsu
Yasuhiro
Y
Takaki
Takashi
T
Nagahama
Takashi
T
Hisabe
Kenshi
K
Yao
Daijiro
D
Higashi
Kitaro
K
Futami
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D004106:Dilatation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab