title: Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn's disease strictures.
abstract: BACKGROUND
  Literature on endoscopic dilation of Crohn's disease (CD) strictures, especially for primary (non-anastomotic) strictures is limited.
  
  
  METHODS
  A historical cohort study was performed on patients who underwent endoscopic stricture dilations for CD in our IBD center. Primary endpoint was the efficacy of first endoscopic dilation in preventing the need for surgery in primary strictures compared to anastomotic strictures. Cox proportional hazards models using robust sandwich covariance matrix estimate were used to evaluate the need for surgery and any further endoscopic intervention.
  
  
  RESULTS
  In our study cohort (mean age 42.2 ± 13.1 years, 57% females, 16.4% current smokers, and median follow-up 1.8 years), 128 patients underwent a total of 430 endoscopic stricture dilations for 169 strictures (88 primary, 81 secondary). Forty-two patients (32.8%) required surgery in the follow-up period, with a mean interval period between first dilation and surgery of 33 months. There was no difference between primary or anastomotic strictures with respect to the need for surgery (34.1% vs. 29.6%, p=0.53), redilation (59.1% vs. 58%, p=0.89) or total interventions (surgery+redilations, 71.6% vs. 72.8%, p=0.86). Multivariable analysis did not show any significant difference between patients who received and did not receive intralesional steroid injections, biologics or immunomodulators with respect to the need for repeat intervention or surgery.
  
  
  CONCLUSIONS
  Efficacy and safety of endoscopic dilation are similar between primary and anastomotic CD strictures. Intralesional steroid injection or use of biologics did not decrease the need for re-intervention or surgery for either primary or anastomotic strictures.
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, United States. Electronic address: ashish.atreja@mssm.edu.
authors.forename: Ashish
authors.initials: A
authors.lastname: Atreja
authors.affiliation: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, United States.
authors.forename: Ashish
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, United States.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Dwivedi
authors.affiliation: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, United States; Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, United States.
authors.forename: Florian
authors.initials: F
authors.lastname: Rieder
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, United States.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, United States.
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, United States.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brzezinski
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, United States.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, United States.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003113:Colonoscopy / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000628:therapy; D003424:Crohn Disease / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D004106:Dilatation / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: Crohn's disease; Endoscopic dilation; Outcomes; Strictures