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01-03-2020 | Ulcerative Colitis

Efficacy and safety of endoscopic balloon dilation in inflammatory bowel disease: results of the large multicenter study of the ENEIDA registry

Authors: Xavier Andújar, Carme Loras, Begoña González, Milena Socarras, Vicente Sanchiz, Maia Boscà, Eugeni Domenech, Margalida Calafat, Esther Rodríguez, Beatriz Sicilia, Xavier Calvet, Jesús Barrio, Jordi Guardiola, Eva Iglesias, María José Casanova, Yolanda Ber, David Monfort, Antonio López-Sanromán, Iago Rodríguez-Lago, Luís Bujanda, Lucía Márquez, María Dolores Martín-Arranz, Yamile Zabana, Fernando Fernández-Bañares, María Esteve, the ENEIDA registry of GETECCU

Published in: Surgical Endoscopy | Issue 3/2020

Abstract

Background

There is no information regarding the outcome of Crohn’s disease (CD) patients treated with endoscopic balloon dilation (EBD) in non-referral hospitals, nor on the efficacy of EBD in ulcerative colitis (UC). We report herein the results of the largest series published to date.

Aim

To assess the efficacy and safety of EBD for inflammatory bowel disease (IBD) stenosis performed in 19 hospitals with different levels of complexity and to determine factors related to therapeutic success.

Methods

We identified IBD patients undergoing EBD in the ENEIDA database. Efficacy of EBD was compared between CD and UC and between secondary and tertiary hospitals. Predictive factors of therapeutic success were assessed with multivariate analysis.

Results

Four-hundred dilations (41.2% anastomotic) were performed in 187 IBD patients (13 UC/Indeterminate colitis). Technical and therapeutic success per dilation was achieved in 79.5% and 55.3%, respectively. Therapeutic success per patient was achieved in 78.1% of cases (median follow-up: 40 months) with 49.7% requiring more than one dilation. No differences related to either diagnosis or hospital complexity was found. Technical success [OR 4.12 (95%CI 2.4–7.1)] and not receiving anti-TNF at the time of dilation [OR 1.7 (95% CI 1.1–2.6)] were independently related to therapeutic success per dilation. A stricture length ≤ 2 cm [HR 2.43 (95% CI 1.11–5.31)] was a predictive factor of long-term success per patient. The rate of major complications was 1.3%.

Conclusions

EBD can be performed with similar efficacy and safety in hospitals with differing levels of complexity and it might be a suitable treatment for UC with short stenosis. To achieve a technical success and the short length of the stenosis seem to be critical for long-term therapeutic success.

Reimund JM, Wittersheim C, Dumont S, Muller CD, Kenney JS, Baumann R et al (1996) Increased production of tumour necrosis factor-alpha interleukin-1 beta, and interleukin-6 by morphologically normal intestinal biopsies from patients with Crohn’s disease. Gut 39(5):684–689CrossRef

McKaig BC, Hughes K, Tighe PJ, Mahida YR (2002) Differential expression of TGF-beta isoforms by normal and inflammatory bowel disease intestinal myofibroblasts. Am J Physiol Cell Physiol 282(1):C172–C182CrossRef

Rieder F, Lawrance IC, Leite A, Sans M (2011) Predictors of fibrostenotic Crohn’s disease. Inflamm Bowel Dis 17(9):2000–2007CrossRef

Pucilowska JB, Williams KL, Lund PK (2010) Fibrogenesis IV. Fibrosis and inflammatory bowel disease: cellular mediators and animal models. Am J Physiol 279(4):653–659

Szabò H, Fiorino G, Spinelli A, Rovida S, Repici A, Malesci AC et al (2010) Review article: anti-fibrotic agents for the treatment of Crohn’s disease—lessons learnt from other diseases. Aliment Pharmacol Ther 31(2):189–201PubMed

Cosnes J, Gower-Rousseau C, Seksik P, Cortot A, Gower-Rousseau C, Seksik P et al (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140(6):1785–1794CrossRef

Solberg IC, Vatn MH, Høie O, Stray N, Sauar J, Jahnsen J et al (2007) Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 5:1430–1438CrossRef

Peyrin-Biroulet L, Loftus EV, Colombel J-F, Sandborn WJ (2010) The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 105(2):289–297CrossRef

Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99:956–963CrossRef

10.

Wibmer AG, Kroesen AJ, Gröne J, Buhr H-J, Ritz J-P (2010) Comparison of strictureplasty and endoscopic balloon dilatation for stricturing Crohn’s disease–review of the literature. Int J Colorectal Dis 25(10):1149–1157CrossRef

11.

Hassan C, Zullo A, DeFrancesco V, Ierardi E, Giustini M, Pitidis A et al (2007) Systematic review: endoscopic dilatation in Crohn’s disease. Aliment Pharmacol Ther 26:1457–1464CrossRef

12.

Thienpont C, D’Hoore A, Vermeire S, Demedts I, Bisschops R, Coremans G et al (2010) Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut 59(3):320–324CrossRef

13.

Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C (2012) Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn’s disease. Aliment Pharmacol Ther 36(2):151–158CrossRef

14.

Bhalme M, Sarkar S, Lal S, Bodger K, Baker R, Willert RP (2014) Endoscopic balloon dilatation of Crohn’s disease strictures: results from a large United kingdom series. Inflamm Bowel Dis 20(2):265–270CrossRef

15.

Morar PS, Faiz O, Warusavitarne J, Brown S, Cohen R, Hind D et al (2015) Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn’s disease strictures. Aliment Pharmacol Ther 42(10):1137–1148CrossRef

16.

Navaneethan U, Lourdusamy V, Njei B, Shen B (2016) Endoscopic balloon dilation in the management of strictures in Crohn???s disease: a systematic review and meta-analysis of non-randomized trials. Surg Endosc Other Interv Tech. 30(12):5434–5443CrossRef

17.

Atreja A, Aggarwal A, Dwivedi S, Rieder F, Lopez R, Lashner BA et al (2014) Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn’s disease strictures. J Crohn’s Colitis. 8(5):392–400CrossRef

18.

Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop Gastrointest Endosc. Am Soc Gastrointest Endosc 71(3):446–454CrossRef

19.

Silverberg MS, Satsangi J, Ahmad T, Arnott IDR, Bernstein CN, Brant SR et al (2005) Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 19(Suppl A):5A–36ACrossRef

20.

Dear KLE, Hunter JO (2001) Colonoscopic hydrostatic balloon dilatation of Crohn’ s strictures. J Clin Gastroenterol 33(4):315–318CrossRef

21.

Blomberg B, Rolny P, Järnerot G (1991) Endoscopic treatment of anastomotic strictures in Crohn’s disease. Endoscopy. 23(4):195–198CrossRef

22.

Ferlitsch A, Reinisch W, Püpök A, Dejaco C, Schillinger M, Schöfl R et al (2006) Safety and efficacy of endoscopic balloon dilation for treatment of Crohn’s disease strictures. Endoscopy 38(5):483–487CrossRef

23.

Thomas-Gibson S, Brooker JC, Hayward CMM, Shah SG, Williams CB, Saunders BP (2003) Colonoscopic balloon dilation of Crohn’s strictures: a review of long-term outcomes. Eur J Gastroenterol Hepatol 15(5):485–488PubMed

24.

Kaplan GG, McCarthy EP, Ayanian JZ, Korzenik J, Hodin R, Sands BE (2008) Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 134(3):680–687CrossRef

25.

Feldman M, Friedman LS, Brandt LJ (2016) Sleisenger and Fordtran’s gastrointestinal and liver disease, vol 2, 10th edn. Elsevier, Amsterdam, p 2616

26.

Sonnenberg A, Genta RM (2015) Epithelial Dysplasia and Cancer in IBD Strictures. J Crohns Colitis. 9(9):769–775CrossRef

27.

Fumery M, Pineton de Chambrun G, Stefanescu C, Buisson A, Bressenot A, Beaugerie L, Amiot A, Altwegg R, Savoye G, Abitbol V, Bouguen G, Simon M, Duffas JP, Hébuterne X, Nancey S, Roblin X, Leteurtre E, Bommelaer G, Lefevre JH, Brunetti F, Guillon F, Bouhn P-BL (2015) Detection of dysplasia or cancer in 3.5% patients with inflammatory bowel disease and colonic strictures. Clin Gastroenterol Hepatol 13(10):1770–1775CrossRef

28.

Khan F, Shen B (2019) Inflammation and neoplasia of the pouch in inflammatory bowel disease. Curr Gastroenterol Rep 21(4):1–7

29.

Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G et al (2018) ECCO-ESCP consensus on surgery for Crohn’s disease. J Crohn’s Colitis 12(1):1–16

30.

East JE, Brooker JC, Rutter MD, Saunders BP (2007) A pilot study of intrastricture steroid versus placebo injection after balloon dilatation of crohn’s strictures. Clin Gastroenterol Hepatol 5(9):1065–1069CrossRef

31.

Loras C, Pérez-Roldan F, Gornals JB, Barrio J, Igea F, González-Huix F et al (2012) Endoscopic treatment with self-expanding metal stents for Crohn’s disease strictures. Aliment Pharmacol Ther 36(9):833–839CrossRef

Title: Efficacy and safety of endoscopic balloon dilation in inflammatory bowel disease: results of the large multicenter study of the ENEIDA registry
Authors: Xavier Andújar
Carme Loras
Begoña González
Milena Socarras
Vicente Sanchiz
Maia Boscà
Eugeni Domenech
Margalida Calafat
Esther Rodríguez
Beatriz Sicilia
Xavier Calvet
Jesús Barrio
Jordi Guardiola
Eva Iglesias
María José Casanova
Yolanda Ber
David Monfort
Antonio López-Sanromán
Iago Rodríguez-Lago
Luís Bujanda
Lucía Márquez
María Dolores Martín-Arranz
Yamile Zabana
Fernando Fernández-Bañares
María Esteve
the ENEIDA registry of GETECCU
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Ulcerative Colitis
Crohn's Disease
Chronic Inflammatory Bowel Disease
Published in: Surgical Endoscopy / Issue 3/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06858-z

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Efficacy and safety of endoscopic balloon dilation in inflammatory bowel disease: results of the large multicenter study of the ENEIDA registry

Abstract

Background

Aim

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Aim

Methods

Results

Conclusions

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