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Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video).
Gastrointest Endosc. 2009 Nov; 70(5):1030-6.GE

Abstract

BACKGROUND

Crohn's disease (CD)-related small-bowel strictures remain a major cause of morbidity, frequently requiring surgery.

OBJECTIVE

Assessment of the feasibility and effectiveness of CD small-bowel stricture dilation by DBE.

DESIGN

Prospective case series.

SETTINGS

Single, tertiary referral center.

METHODS

Outcome data on cases of DBE-assisted CD small-bowel stricture dilation were prospectively collected from 2005. Dilation was performed by using controlled radial expansion balloon dilators. A 10-cm visual analogue scale (VAS) was used to assess obstructive symptoms and dietary restriction before DBE stricture dilation and at follow-up.

RESULTS

A total of 13 DBEs were performed in 11 consecutive patients (mean +/- SD age 46.4 +/- 7.8 years). Eighteen small-bowel stricture dilations were performed in 9 of 11 patients. The mean dilation diameter was 15.4 mm (range 12-20 mm). In 2 cases, stricture dilation was not performed because adhesions made reaching the strictures impossible. One case was complicated by a delayed perforation. In the other 8 patients, stricture dilation was successful; VAS scores improved dramatically and none of the patients has required surgery (mean follow-up 20.5 months; range 2-41 months). During follow-up, 2 patients required repeated dilation (at 6.5 and 13 months, respectively) because of symptom recurrence. Clinical improvements in before and after VAS scores were significant (mean 8.8 vs 1.8, respectively; P < .001).

LIMITATIONS

Small case series; single tertiary referral center.

CONCLUSION

DBE-assisted small-bowel stricture dilation for selected patients with CD is potentially of significant benefit and should be considered as a useful and effective alternative to surgery. Larger studies are required to confirm this benefit.

Authors+Show Affiliations

The Wolfson Unit for Endoscopy, St. Mark's Hospital and Academic Institute, London, England.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19640518

Citation

Despott, Edward J., et al. "Effective Dilation of Small-bowel Strictures By Double-balloon Enteroscopy in Patients With Symptomatic Crohn's Disease (with Video)." Gastrointestinal Endoscopy, vol. 70, no. 5, 2009, pp. 1030-6.
Despott EJ, Gupta A, Burling D, et al. Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video). Gastrointest Endosc. 2009;70(5):1030-6.
Despott, E. J., Gupta, A., Burling, D., Tripoli, E., Konieczko, K., Hart, A., & Fraser, C. (2009). Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video). Gastrointestinal Endoscopy, 70(5), 1030-6. https://doi.org/10.1016/j.gie.2009.05.005
Despott EJ, et al. Effective Dilation of Small-bowel Strictures By Double-balloon Enteroscopy in Patients With Symptomatic Crohn's Disease (with Video). Gastrointest Endosc. 2009;70(5):1030-6. PubMed PMID: 19640518.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video). AU - Despott,Edward J, AU - Gupta,Arun, AU - Burling,David, AU - Tripoli,Eric, AU - Konieczko,Krysia, AU - Hart,Ailsa, AU - Fraser,Chris, Y1 - 2009/07/28/ PY - 2009/01/26/received PY - 2009/05/01/accepted PY - 2009/7/31/entrez PY - 2009/7/31/pubmed PY - 2010/1/20/medline SP - 1030 EP - 6 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 70 IS - 5 N2 - BACKGROUND: Crohn's disease (CD)-related small-bowel strictures remain a major cause of morbidity, frequently requiring surgery. OBJECTIVE: Assessment of the feasibility and effectiveness of CD small-bowel stricture dilation by DBE. DESIGN: Prospective case series. SETTINGS: Single, tertiary referral center. METHODS: Outcome data on cases of DBE-assisted CD small-bowel stricture dilation were prospectively collected from 2005. Dilation was performed by using controlled radial expansion balloon dilators. A 10-cm visual analogue scale (VAS) was used to assess obstructive symptoms and dietary restriction before DBE stricture dilation and at follow-up. RESULTS: A total of 13 DBEs were performed in 11 consecutive patients (mean +/- SD age 46.4 +/- 7.8 years). Eighteen small-bowel stricture dilations were performed in 9 of 11 patients. The mean dilation diameter was 15.4 mm (range 12-20 mm). In 2 cases, stricture dilation was not performed because adhesions made reaching the strictures impossible. One case was complicated by a delayed perforation. In the other 8 patients, stricture dilation was successful; VAS scores improved dramatically and none of the patients has required surgery (mean follow-up 20.5 months; range 2-41 months). During follow-up, 2 patients required repeated dilation (at 6.5 and 13 months, respectively) because of symptom recurrence. Clinical improvements in before and after VAS scores were significant (mean 8.8 vs 1.8, respectively; P < .001). LIMITATIONS: Small case series; single tertiary referral center. CONCLUSION: DBE-assisted small-bowel stricture dilation for selected patients with CD is potentially of significant benefit and should be considered as a useful and effective alternative to surgery. Larger studies are required to confirm this benefit. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/19640518/Effective_dilation_of_small_bowel_strictures_by_double_balloon_enteroscopy_in_patients_with_symptomatic_Crohn's_disease__with_video__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(09)01905-1 DB - PRIME DP - Unbound Medicine ER -