Background: Endoscopic balloon dilation represents a valid therapeutic alternative in patients with inflammatory bowel disease that have colonic symptomatic strictures weather they occur before or after surgery. The aim of this study was to analyze the outcomes and to identify the predictors of success of endoscopic colonic dilation.
Methods: Inclusion criteria: Patients having inflammatory bowel disease with colonic stenosis treated by endoscopic balloon dilation from 2000 to 2015 were enrolled. Patients with a follow up lower than 6 months were excluded.
Technique: Dilation was performed with hydrostatic with variable diameters and pressures, adjusted depending on the stricture type. Procedure was performed under sedation and scopic control. All patients were hospitalized during 24 hours after procedure in order to detect possible complications.
Criteria defining dilation failure: Failure of endoscopic balloon dilation was defined by the need to recourse to a second session or to surgery within six months after the first session of dilation.
Statistic study: Univariate and multivariate analysis were performed SPSS 18/0) in order to identify independent predictors of outcome of endoscopic balloon dilation.
Results: During the study period, a total of 31 dilations have been performed among 18 patients (mean age 49.6 years old and sex ratio of 1,2).
Three patients had ulcerative colitis while fifteen had Crohn's disease since an average duration of 10 years.
Endoscopic treatment was successful in 72% in our cohort after a follow up of 18 months (6–48moths). Six patients needed more than one dilation (2–5dilations), while 2 needed a surgical removal of the stricture. No complication occurred in our study.
In univariate analysis, predictors of outcome of endoscopic balloon dilation were: the age lower to 60 years, an inflammatory stricture, a disease that has been evolving for less than 5 years, a high balloon pressure, the association to a systemic treatment and an elevated level of the C reactive protein. In multivariate analysis, no factor was identified as an independent predictor of outcome of endoscopic balloon dilation.
Conclusions: Endoscopic balloon dilation of stricture during inflammatory bowel disease represents a safe alternative to surgery with a success rate of 72%. It should be privileged in young patients with an inflammatory stricture. It has a better outcome when done with a high balloon pressure and when associated to other therapeutic measures (immunosuppressive treatment). However, larger study should be performed in order to identify independent predictors of outcome of endoscopic balloon dilation.