• Annals of medicine · Dec 2021

    Predictors of necessity for endoscopic balloon dilatation in patients with Crohn's disease-related small bowel stenosis.

    • Yukie Hayashi, Kaoru Takabayashi, Naoki Hosoe, Hiroki Kiyohara, Satoshi Kinoshita, Kosaku Nanki, Kayoko Fukuhara, Yohei Mikami, Tomohisa Sujino, Makoto Mutaguchi, Takaaki Kawaguchi, Motohiko Kato, Haruhiko Ogata, and Takanori Kanai.
    • Division of Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
    • Ann. Med. 2021 Dec 1; 53 (1): 2025-2033.

    Background And AimIn patients with Crohn's disease (CD) and small bowel stenosis, endoscopic balloon dilation (EBD) is considered to be useful in improving stenotic symptoms and avoiding surgery. However, it carries risks such as bleeding and perforation. The aim of this study was to identify the indications for endoscopic intervention in patients with CD and small bowel stenosis.MethodsFrom November 2007 to March 2020, 143 CD patients with small bowel stenosis were enrolled in this study. We identified the factors associated with not requiring endoscopic intervention during long-term follow-up of these patients.ResultsForty of the 143 patients had abdominal symptoms of stenosis and had undergone EBD, whereas the remaining 103 were asymptomatic and had not undergone endoscopic intervention. During long-term follow-up, 95 of those 103 patients never required endoscopic or surgical intervention. Multivariate logistic regression analysis revealed that not consuming an elemental diet (OR 3.18, 95% CI 1.48-6.82; p < .01) and ileocecal valve (ICV) stenosis (OR 0.30, 95% CI 0.11-0.83; p = .02) were independently associated with not requiring EBD. The cumulative emergency hospitalisation-free rate also tended to be higher in patients not consuming an elemental diet or with ICV stenosis.ConclusionsTwo factors, namely not consuming an elemental diet and ICV stenosis, predict a long-term intervention-free prognosis in CD patients with small bowel stenosis.Key messagesWhen an endoscopically impassable small bowel stenosis is found in a CD patient, long-term follow-up without endoscopic intervention may be possible if the patient is asymptomatic, is not using an elemental diet, and the stenosis is ICV.

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