Thomas Lambin1, Aurélien Amiot2, Carmen Stefanescu3, Jean-Marc Gornet4, Philippe Seksik5, David Laharie6, Catherine Reenaers7, Arnaud Bourreille8, Guillaume Cadiot9, Franck Carbonnel10, Nina Dib11, Mathurin Fumery12, Cyrielle Gilletta de St Joseph13, Jérôme Filippi14, Stéphanie Viennot15, Laurianne Plastaras16, Benoit Coffin17, Mélanie Serrero18, Stéphane Nahon19, Guillaume Pineton de Chambrun20, Jean-François Rahier21, Xavier Roblin22, Médina Boualit23, Guillaume Bouguen24, Laurent Peyrin-Biroulet25, Benjamin Pariente26. 1. Department of Gastroenterology, Claude Huriez hospital, University of Lille, Lille, France. 2. Department of Gastroenterology, Hopitaux Universitaires Henri Mondor, AP-HP, EA7375, Universite Paris Creteil, Creteil, France. 3. Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France. 4. Department of Gastroenterology, Saint-Louis Hospital, Paris, France. 5. Sorbonne University, Gastroenterology & Nutrition Department, AP-HP, Hôpital Saint-Antoine, Paris, France. 6. CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France. 7. Department of hepato-gastroenterology and digestive oncology, Liège University Hospital CHU, Liège, Belgium. 8. University of Nantes, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Department of gastroenterology, Nantes, France. 9. Department of gastroenterology, Reims University Hospital, Reims, France. 10. Department of gastroenterology, Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France. 11. Department of gastroenterology, Angers University Hospital, Angers, France. 12. Department of gastroenterology, Amiens University Hospital, and Peritox UMR I-0I, Amiens, France. 13. Department of gastroenterology, Rangueil Hospital, University of Toulouse 3, Toulouse, France. 14. Department of gastroenterology, Nice University Hospital, Nice, France. 15. Department of gastroenterology, University Hospital of Caen, Caen, France. 16. Department of gastroenterology, Hospital Pasteur, Colmar, France. 17. Department of gastroenterology, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 18. Department of gastroenterology, Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France. 19. Department of gastroenterology, GHI Le Raincy-Montfermeil, Montfermeil, France. 20. Department of gastroenterology, Saint-Eloi Hospital, Montpellier University, Montpellier, France. 21. Department of gastroenterology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium. 22. Department of gastroenterology, Saint-Etienne University Hospital, Saint-Étienne, France. 23. Department of gastroenterology, Valenciennes General Hospital, Valenciennes, France. 24. Department of Endoscopy and Gastroenterology, Pontchaillou University Hospital, Rennes, France. 25. Department of gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France; Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France. 26. Department of Gastroenterology, Claude Huriez hospital, University of Lille, Lille, France; Inserm Unit 995, University of Lille 2, Lille, France. Electronic address: benjamin.pariente@chru-lille.fr.
Abstract
BACKGROUND: There are few data concerning patients with Crohn's disease (CD) complicated by a stricture of the upper gastrointestinal tract (UGT). AIMS: We evaluated the outcome and management of CD patients complicated by a stricture of the UGT. METHODS: We performed a retrospective multicenter study including all CD patients with a non-passable symptomatic UGT stricture on endoscopy. Primary outcome measure was surgery-free survival from diagnosis of stricture. Efficacy of medical, endoscopic, and surgical treatments, and identification of predictors of surgery were also evaluated. RESULTS: 60 CD patients with an UGT stricture were included. 60% of the strictures were located in the duodenum. With a median follow-up of 5.5 (IQR: 3.0-12.0) years since stricture diagnosis, surgical-free survival was 75% and 64% at 1 and 5 years, respectively. At the end of the follow up, 27 (45%) patients underwent surgery. 77 endoscopic procedures were performed in 30 patients with an immediate success of 81% and a clinical benefit in 84% of the procedures. In multivariate analysis, anti-TNF treatment initiation was associated with a reduced risk of surgery. CONCLUSION: CD UGT strictures are mainly located in the duodenum. Medical and endoscopic treatments allow to avoid surgery in half of the patients.
BACKGROUND: There are few data concerning patients with Crohn's disease (CD) complicated by a stricture of the upper gastrointestinal tract (UGT). AIMS: We evaluated the outcome and management of CD patients complicated by a stricture of the UGT. METHODS: We performed a retrospective multicenter study including all CD patients with a non-passable symptomatic UGT stricture on endoscopy. Primary outcome measure was surgery-free survival from diagnosis of stricture. Efficacy of medical, endoscopic, and surgical treatments, and identification of predictors of surgery were also evaluated. RESULTS: 60 CD patients with an UGT stricture were included. 60% of the strictures were located in the duodenum. With a median follow-up of 5.5 (IQR: 3.0-12.0) years since stricture diagnosis, surgical-free survival was 75% and 64% at 1 and 5 years, respectively. At the end of the follow up, 27 (45%) patients underwent surgery. 77 endoscopic procedures were performed in 30 patients with an immediate success of 81% and a clinical benefit in 84% of the procedures. In multivariate analysis, anti-TNF treatment initiation was associated with a reduced risk of surgery. CONCLUSION: CD UGT strictures are mainly located in the duodenum. Medical and endoscopic treatments allow to avoid surgery in half of the patients.