title: Salvage surgery after failure of endoscopic balloon dilatation versus surgery first for ileocolonic anastomotic stricture due to recurrent Crohn's disease.
abstract: BACKGROUND
  Both surgical resection and endoscopic balloon dilatation are treatment options for ileocolonic anastomotic stricture caused by recurrent Crohn's disease unresponsive to medications. Perioperative outcomes of salvage surgery owing to failed endoscopic balloon dilatation in comparison with performing surgery first for the same indication are unclear.
  
  
  METHODS
  An analysis of a prospectively maintained Crohn's disease database was carried out to compare perioperative outcomes of patients who had surgery for failure of endoscopic balloon dilatation with outcomes in patients who underwent resection first for ileocolonic anastomotic stricture caused by recurrent Crohn's disease between 1997 and 2013.
  
  
  RESULTS
  Of 194 patients, 114 (58·8 per cent) underwent surgery without previous endoscopic balloon dilatation. The remaining 80 patients had salvage surgery after one or more endoscopic balloon dilatations during a median treatment span of 14·5 months. Patients in the salvage surgery group had a significantly shorter length of anastomotic stricture (P < 0·001). Salvage surgery was associated with increased rates of stoma formation (P = 0·030), overall surgical-site infection (SSI) (P = 0·025) and organ/space SSI (P = 0·030). In multivariable analysis, preoperative endoscopic balloon dilatation was independently associated with both postoperative SSI (odds ratio 3·16, 95 per cent c.i. 1·01 to 9·84; P = 0·048) and stoma diversion (odds ratio 3·33, 1·14 to 9·78; P = 0·028).
  
  
  CONCLUSIONS
  Salvage surgery after failure of endoscopic balloon dilatation is associated with increased adverse outcomes in comparison with surgery first. This should be discussed with patients being considered for endoscopic balloon dilatation for ileocolonic anastomotic stricture due to recurrent Crohn's disease.
authors: Departments of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: Y
authors: Y
authors: Li
authors: Departments of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: L
authors: L
authors: Stocchi
authors: Departments of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: B
authors: B
authors: Shen
authors: Departments of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: X
authors: X
authors: Liu
authors: Departments of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors: F H
authors: FH
authors: Remzi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery / Q000628:therapy; D003424:Crohn Disease / Q000601:surgery*; D004106:Dilatation / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome