In a recent review study entitled “Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn’s disease strictures”, researchers performed a systematic analysis to determine the overall efficacy of endoscopic balloon dilation as a treatment for Crohn’s disease strictures. The study was published in the Alimentary Pharmacology & Therapeutics journal.
Crohn’s disease is one of the most common types of Inflammatory Bowel Disease (IBD), and is estimated to affect 1.4 million Americans. The disease is characterized by inflammation of the intestinal tract (including mouth, esophagus, stomach, small intestine, large intestine, rectum and anus), and can cause a narrowing of the intestines called strictures, which, although they can be found anywhere along the gastrointestinal tract, are most common to occur in the last part of the small intestine and colon. One of the possible treatments for Crohn’s disease strictures is endoscopic balloon dilation.
Here, authors performed a systematic analysis of published studies to understand endoscopic balloon dilation overall efficacy, focusing on symptomatic (SR), technical response (TR) and adverse events (AE) of endoscopic balloon dilation. To this end, researchers searched COCHRANE, MEDLINE and EMBASE databases for original studies on Crohn’s strictures patients’ outcomes for endoscopic balloon dilation. In total, the team analyzed twenty-five studies, including 10 prospective studies, 14 retrospective studies and one randomized controlled trial. Together, the published studies reported the outcomes of 1,089 patients and 2,664 dilatations. Authors defined “symptomatic response as patients with an obstructive symptom-free outcome at the end of follow-up, technical response by the passage of the scope following [endoscopic balloon dilation] and adverse events by the proportion of patients who develop complications.” The team registered as overall scores for SR, TR, complications and perforations 70.2%, 90.6%, 6.4% and 3%, respectively.
In light of these results, authors suggest that endoscopic balloon dilation strategy in the management of Crohn’s strictures needs to be redefined. They point that while 70.2% for SR indicates a short-term benefit, they registered that 75% of the patients submitted to endoscopic balloon dilation required surgery within 5 years of follow-up. Hence, authors highlight that due to the reduced number of 5 year follow-up studies, future studies are required to fully assess if endoscopic balloon dilatation provides long-term benefits to Crohn’s disease patients.