title: Endoscopic balloon dilatation of Crohn's disease strictures: results from a large United kingdom series.
abstract: BACKGROUND
  Stricturing is a common complication of Crohn's disease. Endoscopic balloon dilatation (EBD) offers a valuable alternative to surgical intervention, but there are limited data on factors influencing its safety and efficacy.
  
  
  METHODS
  A multicenter retrospective audit across 4 U.K. teaching hospitals was performed on the use of EBD for Crohn's strictures between 1998 and 2011. Demographics, smoking status, medications, C-reactive protein, endoscopic findings, and subsequent surgery at follow-up were recorded. Success of EBD was defined as symptomatic improvement without the need for surgery at follow-up.
  
  
  RESULTS
  Seventy-nine patients (47 women; median age, 48 yr) were identified for this study. Forty-eight (61%) patients had ileocolonic anastomotic strictures, whereas the rest had de novo strictures. In total, 191 EBDs (range, 1-11; median 2) were carried out on 93 strictures (range, 1-5; median 1) over a median duration of 12 months (range, 1-84). There were no serious adverse events. Success at index EBD was 34%, with a further 43% achieving long-term benefit from additional EBDs. Eighteen (23%) patients required surgery. Time to surgery after the first EDB was 2.6 to 71.1 months (median, 12.8 mo). Longer Crohn's disease duration (P = 0.03) and high C-reactive protein (P = 0.008) were associated with an increased need for subsequent surgery.
  
  
  CONCLUSIONS
  EBD was safe and effective in achieving long-term symptom improvement and avoidance of surgery in most patients. Prospective controlled trials are needed to evaluate the effect of other factors, including Crohn's disease phenotype, and the role of concomitant medication to identify those best suited to EBD.
authors.affiliation: *Royal Bolton Hospital, Bolton, United Kingdom; †Department of Gastroenterology and Hepatology, Royal Liverpool University Hospitals, Liverpool, United Kingdom; ‡Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom; §Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; ‖Digestive Diseases Centre, Clinical Sciences Centre, Aintree University Hospital, Liverpool, United Kingdom; ¶School of Business, Salford University, Salford, United Kingdom; and **Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Bhalme
authors.forename: Sanchoy
authors.initials: S
authors.lastname: Sarkar
authors.forename: Simon
authors.initials: S
authors.lastname: Lal
authors.forename: Keith
authors.initials: K
authors.lastname: Bodger
authors.forename: Rose
authors.initials: R
authors.lastname: Baker
authors.forename: Robert P
authors.initials: RP
authors.lastname: Willert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D003113:Colonoscopy / Q000379:methods*; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004106:Dilatation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult