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Endoscopic balloon dilation of ileal pouch strictures.
Am J Gastroenterol 2004; 99(12):2340-7AJ

Abstract

BACKGROUND

Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in patients with ulcerative colitis. Strictures can occur at the inlet and outlet of the pouch. Endoscopic balloon dilation has been successfully used in patients with Crohn's strictures at the small intestine and colon. There are no published trials on endoscopic balloon therapy of ileal pouch strictures.

AIM

To evaluate outpatient endoscopic balloon dilation of strictures in ileal pouches.

METHODS

Patients underwent nonfluoroscopy-guided, nonsedated, outpatient endoscopic dilations with an 8.6-mm upper endoscope and through-the-scope balloons (size: 11-18 mm). Pre- and posttreatment Pouchitis Disease Activity Index symptom scores (range: 0-6), endoscopic stricture scores based on resistance in passing the endoscope (range: 0-4), and Cleveland Global Quality of Life were compared.

RESULTS

Nineteen patients with pouch strictures who had concurrent Crohn's disease of the pouch (n = 11), cuffitis (n = 5), and pouchitis (n = 3), including 14 inlet and 14 outlet strictures, were enrolled. The mean number of strictures for each patient was 1.61 +/- 0.78. All strictures were successfully dilated with the through-the-scope balloon, with a mean of 1.74 +/- 1.19 (range: 1-5) sessions for each patient. Nine patients had a second endoscopy at 8 wk and five patients had a third pouch endoscopy at 16 wk after the initial endoscopic dilation. Endoscopic stricture scores immediately (0.30 +/- 0.47), 8 wk (0.40 +/- 0.51), and 16 wk (0.44 +/- 0.76) after the dilation were significantly improved compared to the predilation stricture scores (2.67 +/- 0.78). The symptom scores and quality-of-life (QOL) scores improved at week 8 and 16 following dilation, with a mean follow-up of 6.10 +/- 5.83 months (2-25 months). No complications were experienced with the procedure. One patient with CD who failed endoscopic and medical therapy underwent pouch resection.

CONCLUSION

In conjunction with medical therapy, outpatient endoscopic balloon dilation appears safe and effective in treating pouch inlet and outlet strictures, by relieving symptoms, restoring pouch patency, and improving QOL in the majority of patients.

Authors+Show Affiliations

Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15571580

Citation

Shen, Bo, et al. "Endoscopic Balloon Dilation of Ileal Pouch Strictures." The American Journal of Gastroenterology, vol. 99, no. 12, 2004, pp. 2340-7.
Shen B, Fazio VW, Remzi FH, et al. Endoscopic balloon dilation of ileal pouch strictures. Am J Gastroenterol. 2004;99(12):2340-7.
Shen, B., Fazio, V. W., Remzi, F. H., Delaney, C. P., Achkar, J. P., Bennett, A., ... Lashner, B. A. (2004). Endoscopic balloon dilation of ileal pouch strictures. The American Journal of Gastroenterology, 99(12), pp. 2340-7.
Shen B, et al. Endoscopic Balloon Dilation of Ileal Pouch Strictures. Am J Gastroenterol. 2004;99(12):2340-7. PubMed PMID: 15571580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic balloon dilation of ileal pouch strictures. AU - Shen,Bo, AU - Fazio,Victor W, AU - Remzi,Feza H, AU - Delaney,Conor P, AU - Achkar,Jean-Paul, AU - Bennett,Anna, AU - Khandwala,Farah, AU - Brzezinski,Aaron, AU - Doumit,Jhony, AU - Liu,Wendy, AU - Lashner,Bret A, PY - 2004/12/2/pubmed PY - 2005/2/3/medline PY - 2004/12/2/entrez SP - 2340 EP - 7 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 99 IS - 12 N2 - BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in patients with ulcerative colitis. Strictures can occur at the inlet and outlet of the pouch. Endoscopic balloon dilation has been successfully used in patients with Crohn's strictures at the small intestine and colon. There are no published trials on endoscopic balloon therapy of ileal pouch strictures. AIM: To evaluate outpatient endoscopic balloon dilation of strictures in ileal pouches. METHODS: Patients underwent nonfluoroscopy-guided, nonsedated, outpatient endoscopic dilations with an 8.6-mm upper endoscope and through-the-scope balloons (size: 11-18 mm). Pre- and posttreatment Pouchitis Disease Activity Index symptom scores (range: 0-6), endoscopic stricture scores based on resistance in passing the endoscope (range: 0-4), and Cleveland Global Quality of Life were compared. RESULTS: Nineteen patients with pouch strictures who had concurrent Crohn's disease of the pouch (n = 11), cuffitis (n = 5), and pouchitis (n = 3), including 14 inlet and 14 outlet strictures, were enrolled. The mean number of strictures for each patient was 1.61 +/- 0.78. All strictures were successfully dilated with the through-the-scope balloon, with a mean of 1.74 +/- 1.19 (range: 1-5) sessions for each patient. Nine patients had a second endoscopy at 8 wk and five patients had a third pouch endoscopy at 16 wk after the initial endoscopic dilation. Endoscopic stricture scores immediately (0.30 +/- 0.47), 8 wk (0.40 +/- 0.51), and 16 wk (0.44 +/- 0.76) after the dilation were significantly improved compared to the predilation stricture scores (2.67 +/- 0.78). The symptom scores and quality-of-life (QOL) scores improved at week 8 and 16 following dilation, with a mean follow-up of 6.10 +/- 5.83 months (2-25 months). No complications were experienced with the procedure. One patient with CD who failed endoscopic and medical therapy underwent pouch resection. CONCLUSION: In conjunction with medical therapy, outpatient endoscopic balloon dilation appears safe and effective in treating pouch inlet and outlet strictures, by relieving symptoms, restoring pouch patency, and improving QOL in the majority of patients. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/15571580/Endoscopic_balloon_dilation_of_ileal_pouch_strictures_ L2 - http://Insights.ovid.com/pubmed?pmid=15571580 DB - PRIME DP - Unbound Medicine ER -