Endoscopic balloon dilation of colorectal strictures complicating Crohn’s disease: a multicenter study - 17/11/20

Doi : 10.1016/j.clinre.2020.10.006

Marion Tilmant ^a, Mélanie Serrero ^b, Florian Poullenot ^c, Guillaume Bouguen ^d, Benjamin Pariente ^e, Romain Altwegg ^f, Paul Basile ^g, Jérôme Filippi ^h, Pierre Vanelslander ⁱ, Anthony Buisson ^j, Ariane Desjeux ^b, David Laharie ^c, Eric Le Balch ^d, Maria Nachury ^e, Lucile Boivineau ^f, Guillaume Savoye ^g, Xavier Hebuterne ^h, Laurent Poincloux ^j, Lucine Vuitton ^k, Franck Brazier ^a, Clara Yzet ^a, Adnane Lamrani ^l, Laurent Peyrin-Biroulet ^m, Mathurin Fumery ^a,⁎
^a Department of Gastroenterology, Amiens University Hospital, Amiens, France
^b Department of Gastroenterology, Hôpital Nord, Université Méditerranée, Marseille, France
^c Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
^d CHU Rennes, University Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
^e CHU Lille, Department of Gastroenterology, F-59000 Lille, France
^f Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
^g Department of Gastroenterology, Rouen University Hospital, Rouen, France
^h Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
ⁱ Polyclinique Saint-Claude, Saint-Quentin, France
^j Université Clermont Auvergne, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
^k Department of Gastroenterology, Besancon University Hospital, Besancon, France
^l Department of Biostatistics, Amiens University Hospital, Amiens, France
^m Department of Hepato-Gastroenterology and Inserm NGERE, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France

^⁎Corresponding author at: Service d'Hépatogastroenterologie, CHU Amiens Picardie, Rond point du Pr Cabrol, 80054 Amiens, France.Service d'Hépatogastroenterologie, CHU Amiens PicardieRond point du Pr CabrolAmiens80054France

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Highlights

•	Efficacy and safety of endoscopic balloon dilation of colorectal strictures remains poorly investigated in Crohn’s disease.
•	Technical and clinical success of endoscopic balloon dilation of colorectal strictures was high, achieved for 79% and 77%, respectively.
•	Safety of endoscopic balloon dilation of colorectal strictures is similar to ileal strictures in Crohn’s disease (perforation 0.6% per EDB and 2% per patient).
•	Endoscopic balloon dilation of Crohn’s disease -associated colorectal strictures is feasible, efficient and safe, with more than 40% becoming asymptomatic without surgery.

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Abstract

Introduction

While endoscopic balloon dilation (EBD) is widely used to manage ileal strictures, EBD of colorectal strictures remains poorly investigated in Crohn’s disease (CD).

Methods

We performed a retrospective study that included all consecutive CD patients who underwent EBD for native or anastomotic colorectal strictures in 9 tertiary centers between 1999 and 2018. Factors associated with EBD failure were also investigated by logistic regression.

Results

Fifty-seven patients (25 women, median age: 36 years (InterQuartile Range, 31-48) were included. Among the 60 strictures, 52 (87%) were native, 39 (65%) measured < 5 cm and the most frequent location was the left colon (27%). Fifty-seven (95%) were non-passable by the scope and 35 (58%) were ulcerated. Among the 161 EBDs performed (median number of dilations per stricture: 2, IQR 1-3), technical and clinical success were achieved for 79% (n = 116/147) and 77% (n = 88/115), respectively. One perforation occurred (0.6% per EDB and 2% per patient). After a median follow-up of 4.3 years (IQR 2.0-8.4), 24 patients (42%) underwent colonic resection and 24 (42%) were asymptomatic without surgery. One colon lymphoma and one colorectal cancer were diagnosed (3.5% of patients) from endoscopic biopsies and at the time of surgery, respectively. No factor was associated with technical or clinical success.