Endoscopic Balloon Dilation of Crohn`s Disease Strictures With or Without Fluoroscopic Guidance

BACKGROUND: Strictures are common complications in Crohn’s disease (CD). CD-associated strictures are usually managed with medical, endoscopic, and surgical approaches, or combinations. Endoscopic therapy is easier to perform in experienced hand and helpful to avoid the need for surgery. In clinical practice, endoscopic balloon dilatation (EBD) under a fluoroscopic guidance is preferred. The use of fluoroscopy allows for the delineation of the stricture and the orientation of the entire balloon catheter. The use of fluoroscopy exposes the patient, the endoscopist, and the endoscopy nurses to excessive radiation. EBD is performed without fluoroscopic guidance in some cases. However, the benefit of fluoroscopic guidance for dilating CD strictures has not been readily demonstrated. The hypothesis of the study is that there are no significant differences in efficacy and safety between EBD with and without fluoroscopic guidance for CD strictures. The aim of this study is to compare efficacy and safety between EBD with and without fluoroscopic guidance for CD strictures.

METHODS: We performed a retrospective review of EBD for CD strictures between 2016 and 2017. We investigated the technical success and clinical success as the efficacy in EBD with and without fluoroscopic guidance for CD strictures. Technical success was defined as the ability to pass the scope through the stricture after balloon dilation. Clinical success was defined as improved obstructive symptoms.

RESULTS: A total of 43 patients with CD strictures were identified (11 at EBD with fluoroscopic guidance group and 32 at EBD without fluoroscopic guidance group). Technical success was achieved in 10 patients (90.9%) at EBD with fluoroscopic guidance and 32 patients (100%) at EBD without fluoroscopic guidance (P = 0.084). Clinical success was achieved in 4 patients (36.4%) at EBD with fluoroscopic guidance and 18 patients (56.2%) at EBD without fluoroscopic guidance (P = 0.255). Additional surgery was performed in 4 patients (36.4%) at EBD with fluoroscopic guidance and 8 patients (25.0%) at EBD without fluoroscopic guidance (P = 0.469). Secondary EBD was performed in 2 patients (18.2%) at EBD with fluoroscopic guidance and 6 patients (18.8%) at EBD without fluoroscopic guidance (P = 0.967).There were no serious complications in both groups.

CONCLUSION(S): There were no significant differences in efficacy and safety between EBD with and without fluoroscopic guidance for CD strictures. EBD guidance for CD strictures could be safe and effective in the setting without fluoroscopic guidance.