BACKGROUND: Stricturing Crohn's disease is accompanied by a high-risk for bowel resection and subsequent short bowel syndrome. Strictureplasty (SP) and endoscopic balloon dilatation (EBD) have been developed to prevent, or at least delay, the requirement for resection. The goal of this study was to compare the outcome of these two procedures with regard to complications and disease recurrence. METHODS: We conducted a MEDLINE literature search to give a current overview about the safety and efficacy of EBD and SP. RESULTS: The initial search yielded 744 articles. Case reports, reviews and meta-analyses were excluded. Finally, 63 articles (SP, 40 articles; EBD, 23 articles) were used for the review. None of the studies compared the two methods directly. A total of 2,532 patients (SP, n = 1,958; EBD, n = 574) were included. The incidence of perioperative complications after SP was 11% and the incidence of major complications was 5%. The median surgical recurrence rate was 24% after a median follow-up of 46 months. The median technical success for EBD was 90%. Major complications occurred in 3% of the cases. According to an intention-to-treat protocol, the median surgical recurrence rate was 27.6%. Per-protocol analysis revealed a median surgical recurrence rate of 21.4% after a median follow-up of 21 months. CONCLUSION: Due to the lack of comparable data, there is currently no reliable information on whether one treatment option is superior to the other. Regarding the limited applicability of EBD in strictures of the small bowel, only a controlled trial would provide evidence as a basis for clinical decision making in CD strictures that are potentially treatable by EBD and SP.
BACKGROUND: Stricturing Crohn's disease is accompanied by a high-risk for bowel resection and subsequent short bowel syndrome. Strictureplasty (SP) and endoscopic balloon dilatation (EBD) have been developed to prevent, or at least delay, the requirement for resection. The goal of this study was to compare the outcome of these two procedures with regard to complications and disease recurrence. METHODS: We conducted a MEDLINE literature search to give a current overview about the safety and efficacy of EBD and SP. RESULTS: The initial search yielded 744 articles. Case reports, reviews and meta-analyses were excluded. Finally, 63 articles (SP, 40 articles; EBD, 23 articles) were used for the review. None of the studies compared the two methods directly. A total of 2,532 patients (SP, n = 1,958; EBD, n = 574) were included. The incidence of perioperative complications after SP was 11% and the incidence of major complications was 5%. The median surgical recurrence rate was 24% after a median follow-up of 46 months. The median technical success for EBD was 90%. Major complications occurred in 3% of the cases. According to an intention-to-treat protocol, the median surgical recurrence rate was 27.6%. Per-protocol analysis revealed a median surgical recurrence rate of 21.4% after a median follow-up of 21 months. CONCLUSION: Due to the lack of comparable data, there is currently no reliable information on whether one treatment option is superior to the other. Regarding the limited applicability of EBD in strictures of the small bowel, only a controlled trial would provide evidence as a basis for clinical decision making in CD strictures that are potentially treatable by EBD and SP.
Authors: Charles N Bernstein; Andre Wajda; Lawrence W Svenson; Adrian MacKenzie; Mieke Koehoorn; Maureen Jackson; Richard Fedorak; David Israel; James F Blanchard Journal: Am J Gastroenterol Date: 2006-07 Impact factor: 10.864
Authors: Klaus Stienecker; Daniel Gleichmann; Ulrike Neumayer; H Joachim Glaser; Carolin Tonus Journal: World J Gastroenterol Date: 2009-06-07 Impact factor: 5.742
Authors: A Ferlitsch; W Reinisch; A Püspök; C Dejaco; M Schillinger; R Schöfl; R Pötzi; A Gangl; H Vogelsang Journal: Endoscopy Date: 2006-05 Impact factor: 10.093
Authors: Ekaterina Krauss; Abbas Agaimy; Angelina Gottfried; Juergen Maiss; Thomas Weidinger; Heinz Albrecht; Arndt Hartmann; Werner Hohenberger; Markus F Neurath; Hermann Kessler; Jonas Mudter Journal: Int J Clin Exp Pathol Date: 2014-10-15
Authors: Nicola de'Angelis; Maria Clotilde Carra; Osvaldo Borrelli; Barbara Bizzarri; Francesca Vincenzi; Fabiola Fornaroli; Giuseppina De Caro; Gian Luigi de'Angelis Journal: World J Gastroenterol Date: 2013-05-07 Impact factor: 5.742