Outcomes of endoscopic therapy for luminal strictures in Crohn's disease

Raina Shivashankar, Jithinraj Edakkanambeth Varayil, W. Scott Harmsen, William Alvis Faubion, Louis M.Wong Kee Song, David H Bruining, Kenneth W. Schroeder, John B Kisiel, Edward Vincent Loftus, Jr, Nayantara Coelho Prabhu

Research output: Contribution to journalArticle

Abstract

Backgrounds: We sought to describe the outcomes of endoscopic therapy of luminal strictures in patients with Crohn's disease (CD) at a large tertiary referral center. Methods: All patients who had undergone endoscopic dilation of CD strictures between January 1, 1990 and November 30, 2013 were identified. Demographics, disease characteristics including medication use and history of surgeries, details of endoscopic procedures, and long-term outcomes were analyzed. A successful procedure was defined as ability of the endoscope to pass through the stricture after dilation or effacement of the dilating balloon under fluoroscopy. Kaplan-Meier and Cox proportional hazards analysis were used. Results: For this study 286 index procedures for CD-related stricture dilation were performed in 273 patients (53.8% women) with median age of 45.9 years (range, 14.9-92.2). The most common stricture locations were ileocolonic anastomosis (36.4%) and colon (13.9%). One hundred fourteen (41.8%) patients had a second dilation. The cumulative probability of need for a second dilation following the index procedure was 33.6% at 1 year (95% CI, 25.9%-38.7%), 53.9% at 3 years (45.9%-61.2%), and 60.2% at 5 years (51.4%-67.5%). Six adverse events occurred after the first procedure: 4 perforations, 1 patient with bleeding, and 1 patient with abdominal pain requiring hospitalization. A total of 82 (30%) patients required surgery for their stricture. Conclusions: In a large cohort, endoscopic stricture dilation in CD was safe and effective. About 33% of patients required a second dilation at 1 year after the initial dilation; younger age and smaller inner diameter of the index stricture predicted need for a second dilation.

Original languageEnglish (US)
Pages (from-to)1575-1581
Number of pages7
JournalInflammatory Bowel Diseases
Volume24
Issue number7
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Crohn Disease
Dilatation
Pathologic Constriction
Therapeutics
Endoscopes
Fluoroscopy
Tertiary Care Centers
Abdominal Pain
Colon
Hospitalization
Demography
Hemorrhage

Keywords

  • Endoscopic dilation
  • Inflammatory bowel disease
  • Strictures

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Shivashankar, R., Varayil, J. E., Harmsen, W. S., Faubion, W. A., Song, L. M. W. K., Bruining, D. H., ... Prabhu, N. C. (2018). Outcomes of endoscopic therapy for luminal strictures in Crohn's disease. Inflammatory Bowel Diseases, 24(7), 1575-1581. https://doi.org/10.1093/ibd/izy049

Outcomes of endoscopic therapy for luminal strictures in Crohn's disease. / Shivashankar, Raina; Varayil, Jithinraj Edakkanambeth; Harmsen, W. Scott; Faubion, William Alvis; Song, Louis M.Wong Kee; Bruining, David H; Schroeder, Kenneth W.; Kisiel, John B; Loftus, Jr, Edward Vincent; Prabhu, Nayantara Coelho.

In: Inflammatory Bowel Diseases, Vol. 24, No. 7, 01.01.2018, p. 1575-1581.

Research output: Contribution to journalArticle

Shivashankar, R, Varayil, JE, Harmsen, WS, Faubion, WA, Song, LMWK, Bruining, DH, Schroeder, KW, Kisiel, JB, Loftus, Jr, EV & Prabhu, NC 2018, 'Outcomes of endoscopic therapy for luminal strictures in Crohn's disease', Inflammatory Bowel Diseases, vol. 24, no. 7, pp. 1575-1581. https://doi.org/10.1093/ibd/izy049
Shivashankar R, Varayil JE, Harmsen WS, Faubion WA, Song LMWK, Bruining DH et al. Outcomes of endoscopic therapy for luminal strictures in Crohn's disease. Inflammatory Bowel Diseases. 2018 Jan 1;24(7):1575-1581. https://doi.org/10.1093/ibd/izy049
Shivashankar, Raina ; Varayil, Jithinraj Edakkanambeth ; Harmsen, W. Scott ; Faubion, William Alvis ; Song, Louis M.Wong Kee ; Bruining, David H ; Schroeder, Kenneth W. ; Kisiel, John B ; Loftus, Jr, Edward Vincent ; Prabhu, Nayantara Coelho. / Outcomes of endoscopic therapy for luminal strictures in Crohn's disease. In: Inflammatory Bowel Diseases. 2018 ; Vol. 24, No. 7. pp. 1575-1581.
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abstract = "Backgrounds: We sought to describe the outcomes of endoscopic therapy of luminal strictures in patients with Crohn's disease (CD) at a large tertiary referral center. Methods: All patients who had undergone endoscopic dilation of CD strictures between January 1, 1990 and November 30, 2013 were identified. Demographics, disease characteristics including medication use and history of surgeries, details of endoscopic procedures, and long-term outcomes were analyzed. A successful procedure was defined as ability of the endoscope to pass through the stricture after dilation or effacement of the dilating balloon under fluoroscopy. Kaplan-Meier and Cox proportional hazards analysis were used. Results: For this study 286 index procedures for CD-related stricture dilation were performed in 273 patients (53.8{\%} women) with median age of 45.9 years (range, 14.9-92.2). The most common stricture locations were ileocolonic anastomosis (36.4{\%}) and colon (13.9{\%}). One hundred fourteen (41.8{\%}) patients had a second dilation. The cumulative probability of need for a second dilation following the index procedure was 33.6{\%} at 1 year (95{\%} CI, 25.9{\%}-38.7{\%}), 53.9{\%} at 3 years (45.9{\%}-61.2{\%}), and 60.2{\%} at 5 years (51.4{\%}-67.5{\%}). Six adverse events occurred after the first procedure: 4 perforations, 1 patient with bleeding, and 1 patient with abdominal pain requiring hospitalization. A total of 82 (30{\%}) patients required surgery for their stricture. Conclusions: In a large cohort, endoscopic stricture dilation in CD was safe and effective. About 33{\%} of patients required a second dilation at 1 year after the initial dilation; younger age and smaller inner diameter of the index stricture predicted need for a second dilation.",
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