Xavier Andújar1,2, Carme Loras3,4, Begoña González5,2, Milena Socarras5,2, Vicente Sanchiz6, Maia Boscà6, Eugeni Domenech7, Margalida Calafat7, Esther Rodríguez8, Beatriz Sicilia9, Xavier Calvet10,2, Jesús Barrio11, Jordi Guardiola12, Eva Iglesias13, María José Casanova14,2, Yolanda Ber15, David Monfort16, Antonio López-Sanromán17, Iago Rodríguez-Lago18, Luís Bujanda19,2, Lucía Márquez20, María Dolores Martín-Arranz21, Yamile Zabana1,2, Fernando Fernández-Bañares1,2, María Esteve1,2. 1. Department of Gastroenterology, Endoscopy Unit, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Plaça Dr Robert nº 5, Terrassa, 08221, Barcelona, Catalonia, Spain. 2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 3. Department of Gastroenterology, Endoscopy Unit, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Plaça Dr Robert nº 5, Terrassa, 08221, Barcelona, Catalonia, Spain. cloras@mutuaterrassa.cat. 4. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. cloras@mutuaterrassa.cat. 5. Hospital Clínic de Barcelona, Barcelona, Spain. 6. Hospital Clínico Universitario de Valencia, Valencia, Spain. 7. Hospital Germans Trias i Pujol, Barcelona, Spain. 8. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz De Tenerife, Spain. 9. Complejo Asistencial Universitario de Burgos, Burgos, Spain. 10. Corporació Sanitària Universitària Parc Taulí, Barcelona, Spain. 11. Hospital Rio Hortega, León, Spain. 12. Hospital Universitari de Bellvitge, Barcelona, Spain. 13. Hospital Universitario Reina Sofía, Córdoba, Spain. 14. Hospital Universitario de La Princesa, Madrid, Spain. 15. Hospital Lozano Blesa, Zaragoza, Spain. 16. Consorci Sanitari de Terrassa, Barcelona, Spain. 17. Hospital Universitario Ramón y Cajal, Madrid, Spain. 18. Hospital de Galdakao, Bizkaia, Spain. 19. Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), Gipuzkua, Spain. 20. Hospital del Mar, Barcelona, Spain. 21. Hospital La Paz, Madrid, Spain.
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.
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 IBDpatients 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 IBDpatients (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.
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