P S Morar1,2, O Faiz1,2, J Warusavitarne1,2, S Brown3, R Cohen4, D Hind5, J Abercrombie6, K Ragunath6, D S Sanders3, I Arnott7, G Wilson7, S Bloom4, N Arebi1,2. 1. Department of Surgery and Cancer, Imperial College, London, UK. 2. St Mark's Hospital, London, UK. 3. Sheffield Teaching Hospitals, Sheffield, UK. 4. University College Hospital, London, UK. 5. Clinical Trials Research Unit, University of Sheffield, Sheffield, UK. 6. NIHR Nottingham Digestive Disease Biomedical Research Unit, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK. 7. Departments of Gastroenterology and Colorectal Surgery, Western General Hospital, Edinburgh, UK.
Abstract
BACKGROUND: Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies. AIM: To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored. METHODS: A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics. RESULTS: Twenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60-78.8%), 90.6% (95% CI: 87.8-92.8%), 6.4% (95% CI: 5.0-8.2) and 3% (95% CI: 2.2-4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis. CONCLUSIONS: Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
BACKGROUND: Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies. AIM: To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored. METHODS: A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics. RESULTS: Twenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60-78.8%), 90.6% (95% CI: 87.8-92.8%), 6.4% (95% CI: 5.0-8.2) and 3% (95% CI: 2.2-4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis. CONCLUSIONS: Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
Authors: Christopher Andrew Lamb; Nicholas A Kennedy; Tim Raine; Philip Anthony Hendy; Philip J Smith; Jimmy K Limdi; Bu'Hussain Hayee; Miranda C E Lomer; Gareth C Parkes; Christian Selinger; Kevin J Barrett; R Justin Davies; Cathy Bennett; Stuart Gittens; Malcolm G Dunlop; Omar Faiz; Aileen Fraser; Vikki Garrick; Paul D Johnston; Miles Parkes; Jeremy Sanderson; Helen Terry; Daniel R Gaya; Tariq H Iqbal; Stuart A Taylor; Melissa Smith; Matthew Brookes; Richard Hansen; A Barney Hawthorne Journal: Gut Date: 2019-09-27 Impact factor: 23.059
Authors: G Pellino; D S Keller; G M Sampietro; I Angriman; M Carvello; V Celentano; F Colombo; F Di Candido; S Laureti; G Luglio; G Poggioli; M Rottoli; S Scaringi; G Sciaudone; G Sica; L Sofo; S Leone; S Danese; A Spinelli; G Delaini; F Selvaggi Journal: Tech Coloproctol Date: 2020-03-14 Impact factor: 3.781
Authors: Michał Łodyga; Piotr Eder; Magdalena Gawron-Kiszka; Agnieszka Dobrowolska; Maciej Gonciarz; Marek Hartleb; Maria Kłopocka; Ewa Małecka-Wojciesko; Piotr Radwan; Jarosław Reguła; Edyta Zagórowicz; Grażyna Rydzewska Journal: Prz Gastroenterol Date: 2021-11-19
Authors: Belinda De Simone; Justin Davies; Elie Chouillard; Salomone Di Saverio; Frank Hoentjen; Antonio Tarasconi; Massimo Sartelli; Walter L Biffl; Luca Ansaloni; Federico Coccolini; Massimo Chiarugi; Nicola De'Angelis; Ernest E Moore; Yoram Kluger; Fikri Abu-Zidan; Boris Sakakushev; Raul Coimbra; Valerio Celentano; Imtiaz Wani; Tadeja Pintar; Gabriele Sganga; Isidoro Di Carlo; Dario Tartaglia; Manos Pikoulis; Maurizio Cardi; Marc A De Moya; Ari Leppaniemi; Andrew Kirkpatrick; Vanni Agnoletti; Gilberto Poggioli; Paolo Carcoforo; Gian Luca Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2021-05-11 Impact factor: 5.469