CLINICAL OUTCOMES OF ENDOSCOPIC BALLOON DILATION FOR SMALL-BOWEL STRICTURES IN PATIENTS WITH NON-CROHN'S DISEASE

Recently, the efficacy of endoscopic balloon dilation (EBD) for small-bowel strictures in patients with Crohn’s disease (CD) was reported. However, an efficacy of EBD for small-bowel strictures in non-CD patients has not been reported. The efficacy and safety of EBD for small-bowel strictures of non-CD patients compared with CD patients were evaluated. In total 98 consecutive patients (mean age, 53 years; average observation period, 46 months) with small-bowel strictures diagnosed by double balloon endoscopy (DBE) were retrospectively evaluated at Hiroshima University Hospital from August 2003 to April 2017. The average procedure time, short-term and long-term success rate of EBD, and the safety profile between non-CD and CD groups were examined. Indications for EBD were as follows: 1) small-bowel strictures causing obstructive symptoms or oral intestinal extension; 2) benign (non-malignant) strictures and inability to pass the scope; 3) stricture length ≤ 5 cm; 4) no fistula, abscess, deep ulceration, severe adhesion, or curvature of the strictures. Short-term success of EBD was defined as the disappearance of abdominal symptoms from gastrointestinal obstruction, and long-term success of EBD as surgical avoidance for over 1 year. Surgery was selected as the initial treatment in 27 cases of the non-CD group (47%, 27/47) and 18 cases of the CD group (44%, 18/41) in a total of 45 cases (46%). In the non-CD group, 14 patients (52%, 14/27) had strictures due to malignant tumor. Thirteen patients had benign strictures (48%, 13/48). Twenty-three patients received EBD (non-CD group, 12 patients; CD group, 11 patients). The non-CD group included 3 cases of intestinal tuberculosis, 3 cases of Non-Steroidal Anti-Inflammatory Drugs ulceration, 2 cases of complete response (CR) after chemotherapy for malignant lymphoma, 2 cases of ischemic enteritis, and other 2 cases. Average EBD time per stricture site was 2.5 in the non-CD group and 2.4 in the CD group. The short-term success rate was 100% (23/23). The long-term success rate was 92% (11/12) in the non-CD group and 82% (9/11) in CD group. Five patients underwent surgery during the observation period, 2 patients in non-CD group (17%, 2/12) and 3 patients in CD group (27%, 3/11). Two patients underwent surgery more than 1 year after initial EBD. There were no significant differences in the surgical-free rate between non-CD and CD patients. Only one adverse event was encountered of bleeding after EBD in non-CD group (8%, 1/12). Although this patient required blood transfusion, the bleeding stopped conservatively. EBD for small-bowel strictures achieved good clinical outcomes in both non-CD and CD patients.