title: Long-term Outcomes in Patients with Small Intestinal Strictures Secondary to Crohn's Disease After Double-balloon Endoscopy-assisted Balloon Dilation.
abstract: BACKGROUND
  Crohn's disease (CD) strictures of the small intestine are a feared complication and difficult to treat because of difficulty gaining access to the stricture site. The development of double-balloon endoscopy (DBE) enabled access to the entire small intestine with interventional capabilities. The aim of this study was to assess the long-term outcomes in patients with small intestinal strictures secondary to CD after DBE-assisted endoscopic balloon dilation (EBD).
  
  
  METHODS
  In this retrospective cohort study, DBE-assisted EBD was performed in 85 consecutive patients with CD strictures of the small intestine from 2002 to 2014. Follow-up data were available for 85 patients for a mean of 41.9 months (range, 0-141), and clinical outcomes were assessed.
  
  
  RESULTS
  Overall, 321 DBE-assisted EBD sessions (473 procedures) were performed in 85 patients during the study period. Most CD strictures were de novo (97%). The surgery-free rate after initial DBE-assisted EBD was 87.3% at 1 year and 78.1% at 3 years. The presence of a fistula was significantly associated with the need for surgical intervention (hazard ratio = 5.50, 95% confidence interval: 2.16-14.0, P < 0.01). The surgery-free interval in patients with a fistula was significantly shorter than in patients without a fistula (P < 0.01, log-rank test).
  
  
  CONCLUSIONS
  DBE-assisted EBD provides a favorable long-term outcome in patients with small intestinal CD-associated strictures. DBE-assisted EBD for CD strictures is a safe and effective treatment to avoid or postpone surgery over the long-term.
authors.affiliation: *Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan; †Shinozaki Medical Clinic, Tochigi, Japan; and ‡Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shinozaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Nagayama
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Takahito
authors.initials: T
authors.lastname: Takezawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ino
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Miura
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation*; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000628:therapy; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult