BACKGROUND AND STUDY AIMS: Endoscopic balloon dilation of Crohn's strictures is widely practised, but may not result in long-term symptomatic benefit, leading to the need for repeat dilation or surgery. It is hypothesized that long-acting steroid injection into strictures after dilation may decrease the need for further stricture dilation and improve the outcome in symptomatic patients. PATIENTS AND METHODS: Patients with Crohn's disease who have had balloon dilation and triamcinolone injection performed for symptomatic anastomotic strictures were identified from endoscopy records. Case notes were reviewed to determine outcomes. RESULTS: Fourteen patients underwent a total of 26 dilations, with triamcinolone injected (median dose 20 mg, 10-40 mg) in 20 of the procedures. Seven patients (50%) had sustained remission after a single dilation and steroid injection, with a median follow-up period of 16.4 months (range 13.2-22.0 months). Four patients (28.5%) required more than one dilation (median three dilations, range two to four) to control their symptoms, with a median follow-up period of 27.8 months (range 14-32.8 months). Endoscopic management failed in three patients (21.4 %), who were referred for surgery. There were no complications due to dilation or triamcinolone injection. CONCLUSIONS: Triamcinolone injection into the stricture after dilation is safe, easy to perform, and may be a useful adjunct in the management of anastomotic Crohn's strictures. These data will require further support through a randomized and controlled trial.
BACKGROUND AND STUDY AIMS: Endoscopic balloon dilation of Crohn's strictures is widely practised, but may not result in long-term symptomatic benefit, leading to the need for repeat dilation or surgery. It is hypothesized that long-acting steroid injection into strictures after dilation may decrease the need for further stricture dilation and improve the outcome in symptomatic patients. PATIENTS AND METHODS: Patients with Crohn's disease who have had balloon dilation and triamcinolone injection performed for symptomatic anastomotic strictures were identified from endoscopy records. Case notes were reviewed to determine outcomes. RESULTS: Fourteen patients underwent a total of 26 dilations, with triamcinolone injected (median dose 20 mg, 10-40 mg) in 20 of the procedures. Seven patients (50%) had sustained remission after a single dilation and steroid injection, with a median follow-up period of 16.4 months (range 13.2-22.0 months). Four patients (28.5%) required more than one dilation (median three dilations, range two to four) to control their symptoms, with a median follow-up period of 27.8 months (range 14-32.8 months). Endoscopic management failed in three patients (21.4 %), who were referred for surgery. There were no complications due to dilation or triamcinolone injection. CONCLUSIONS:Triamcinolone injection into the stricture after dilation is safe, easy to perform, and may be a useful adjunct in the management of anastomotic Crohn's strictures. These data will require further support through a randomized and controlled trial.
Authors: Jörg C Hoffmann; Frank Heller; Siegbert Faiss; Bernd von Lampe; Anton J Kroesen; Ulrich Wahnschaffe; Jörg-Dieter Schulzke; Martin Zeitz; Christian Bojarski Journal: Int J Colorectal Dis Date: 2008-03-13 Impact factor: 2.571
Authors: Klaus Stienecker; Daniel Gleichmann; Ulrike Neumayer; H Joachim Glaser; Carolin Tonus Journal: World J Gastroenterol Date: 2009-06-07 Impact factor: 5.742