title: Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures.
abstract: BACKGROUND
  Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies.
  
  
  OBJECTIVE
  To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored.
  
  
  METHODS
  A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics.
  
  
  RESULTS
  Twenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60-78.8%), 90.6% (95% CI: 87.8-92.8%), 6.4% (95% CI: 5.0-8.2) and 3% (95% CI: 2.2-4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis.
  
  
  CONCLUSIONS
  Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|St Mark's Hospital, London, UK.
authors.forename: P S
authors.initials: PS
authors.lastname: Morar
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|St Mark's Hospital, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Faiz
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|St Mark's Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Warusavitarne
authors.affiliation: Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.affiliation: University College Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hind
authors.affiliation: NIHR Nottingham Digestive Disease Biomedical Research Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Abercrombie
authors.affiliation: NIHR Nottingham Digestive Disease Biomedical Research Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ragunath
authors.affiliation: Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
authors.affiliation: Departments of Gastroenterology and Colorectal Surgery, Western General Hospital, Edinburgh, UK.
authors.forename: I
authors.initials: I
authors.lastname: Arnott
authors.affiliation: Departments of Gastroenterology and Colorectal Surgery, Western General Hospital, Edinburgh, UK.
authors.forename: G
authors.initials: G
authors.lastname: Wilson
authors.affiliation: University College Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bloom
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|St Mark's Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Arebi
mesh_terms: D003251:Constriction, Pathologic / Q000628:therapy; D003424:Crohn Disease / Q000150:complications / Q000628:therapy*; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome