title: Heterogeneity in endoscopic treatment of Crohn's disease-associated strictures: An international inflammatory bowel disease specialist survey.
abstract: BACKGROUND
  Crohn's disease (CD) is frequently complicated by intestinal strictures, which are commonly treated by endoscopic balloon dilation (EBD). However, available data on this area of treatment is limited. The aim of this study was to depict the heterogeneity of endoscopic management of CD-associated strictures among international CD specialists to identify common treatment standards.
  
  
  METHODS
  IBD experts of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD), the European Crohn's and Colitis Organization (ECCO), and from the Prospective Value In IBD trials (PROVIT) completed a web-based questionnaire to evaluate their endoscopic experience, practice setting, and number of EBDs performed annually. Additionally, two case scenarios and technical practice parameters were investigated.
  
  
  RESULTS
  A total of 126 subjects from 15 countries completed the survey. The maximal length of dilated stricture was 4.5 ± 1.7 cm. The most commonly used maximal balloon size was graded as 15-18 mm. While 87.2 % of the participants favored EBD for anastomotic strictures, only 58.6 % did so in the case of naïve strictures. Only 35.7 % of physicians dilated actively inflamed strictures. Interventional endoscopists were more likely to dilate only clinically symptomatic strictures (p = 0.046). Surgeons favored surgical treatment of de novo ileocecal strictures compared to gastroenterologists (p = 0.026), reported a shorter stricture length being amendable by EBD (p = 0.045), and more frequently used concomitant therapies (p = 0.001). Operator experience increased the likelihood of EBD use in actively inflamed strictures (p = 0.002), maximum length of stricture, and maximum balloon size (p = 0.001).
  
  
  CONCLUSIONS
  EBD is a widely used treatment approach for stricturing CD. Individual approaches differ significantly based on background of the operator, experience level, and practice setting.
authors.affiliation: Department of Medicine B, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany. dominik.bettenworth@ukmuenster.de.
authors.forename: Dominik
authors.initials: D
authors.lastname: Bettenworth
authors.affiliation: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Hindryckx
authors.affiliation: Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Levesque
authors.affiliation: Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.|Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Florian
authors.initials: F
authors.lastname: Rieder
mesh_terms: D002429:Cecal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002983:Clinical Competence; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D003424:Crohn Disease / Q000150:complications*; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal; D005060:Europe; D005762:Gastroenterology; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D009656:North America; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D011365:Professional Practice Location; D013043:Specialties, Surgical; D011795:Surveys and Questionnaires
keywords: Balloon dilation; Crohn’s disease; Intestinal stricture
references.citation: Fibrogenesis Tissue Repair. 2014 Mar 29;7(1):5
references.pmid: 24678903
references.citation: Endoscopy. 2004 Nov;36(11):1001-7
references.pmid: 15520920
references.citation: Dis Colon Rectum. 2006 Oct;49(10 Suppl):S59-67
references.pmid: 17106817
references.citation: Am J Gastroenterol. 2012 Nov;107(11):1693-701
references.pmid: 22945286
references.citation: World J Gastroenterol. 2013 Jan 7;19(1):86-91
references.pmid: 23326167
references.citation: Int J Colorectal Dis. 2010 Oct;25(10):1149-57
references.pmid: 20628881
references.citation: Am J Gastroenterol. 2014 Jan;109(1):23-34; quiz 35
references.pmid: 24322839
references.citation: Clin Gastroenterol Hepatol. 2007 Sep;5(9):1065-9
references.pmid: 17627903
references.citation: Br J Surg. 1991 Apr;78(4):453-4
references.pmid: 2032105
references.citation: Gastrointest Endosc. 2013 Dec;78(6):819-35
references.pmid: 24139079
references.citation: Inflamm Bowel Dis. 2015 Sep;21(9):2222-40
references.pmid: 26284298
references.citation: Gut. 1995 Apr;36(4):577-80
references.pmid: 7737567
references.citation: Eur J Gastroenterol Hepatol. 2003 May;15(5):485-8
references.pmid: 12702904
references.citation: Clin Gastroenterol Hepatol. 2007 Dec;5(12):1430-8
references.pmid: 18054751
references.citation: Dis Colon Rectum. 2007 Nov;50(11):1968-86
references.pmid: 17762967
references.citation: Gut. 2005 Feb;54(2):237-41
references.pmid: 15647188
references.citation: Gut. 1984 Jun;25(6):665-72
references.pmid: 6735250
references.citation: Dig Dis. 2014;32 Suppl 1:35-8
references.pmid: 25531351
references.citation: Gut. 1989 Jul;30(7):990-5
references.pmid: 2759493
references.citation: Aliment Pharmacol Ther. 2012 Nov;36(9):833-9
references.pmid: 22966851
references.citation: World J Gastroenterol. 2013 May 7;19(17):2660-7
references.pmid: 23674873
references.citation: Aliment Pharmacol Ther. 2012 Jul;36(2):151-8
references.pmid: 22612326
references.citation: Lancet. 2012 Nov 3;380(9853):1590-605
references.pmid: 22914295
references.citation: J Crohns Colitis. 2009 Dec;3(4):250-6
references.pmid: 21172283
references.citation: Z Gastroenterol. 2003 Jan;41(1):11-7
references.pmid: 12541166
references.citation: Inflamm Bowel Dis. 2015 Sep;21(9):2194-213
references.pmid: 25985249
references.citation: Endoscopy. 1991 Jul;23(4):195-8
references.pmid: 1915133
references.citation: Gut. 2013 Jul;62(7):1072-84
references.pmid: 23626373
references.citation: Aliment Pharmacol Ther. 2007 Dec;26(11-12):1457-64
references.pmid: 17903236
references.citation: J Crohns Colitis. 2014 May;8(5):392-400
references.pmid: 24189349
references.citation: J Crohns Colitis. 2013 Dec;7(12):982-1018
references.pmid: 24184171
references.citation: Int J Clin Exp Pathol. 2014 Oct 15;7(11):7419-31
references.pmid: 25550777
references.citation: Gut. 2010 Mar;59(3):320-4
references.pmid: 19840991