Paper

Long Term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy

Clara Thienpont, Gert Van Assche^*, Séverine Vermeire, Ingrid Demedts, Raf Bisschops, Georges Coremans, Paul Rutgeerts

University Hospital Gsthuisberg, Belgium

Correspondence to: GERT VAN ASSCHE, UNIVERSITY HOSPITAL LEUVEN, CENTRE FOR GI RESEARCH, UNIVERSITY OF LEUVEN, B-3000 LEUVEN, /, /, Belgium; gert.vanassche{at}uz.kuleuven.ac.be

Accepted 4 September 2009

Background: Endoscopic dilation of Crohn’s disease related strictures is an alternative to surgical resection in selected patients. The influence of disease activity and concomitant medical therapy on long term outcomes is largely unknown.

Aim and methods: to study long term safety and efficacy of stricture dilatation in a single center cohort.

Results: between 1995 and 2006, 237 dilatations where performed in 138 patients (mean age 50.6 +/- 13.4, 56% female) for a clinically obstructive stricture (< 5 cm, 84% anastomotic). Immediate success of a first dilatation was 97% with a 5% serious complication rate. After a median follow-up of 5.8 years (IQR 3;0-8.4), recurrent obstructive symptoms lead to a new dilatation in 46% or surgery in 24%. Elevated CRP levels nor endoscopic disease activity predicted the need for new intervention. None of the concomitant therapies influenced the outcome.

Conclusion: This largest series ever reported confirms that long term efficacy of endoscopic CD dilatation outweighs the complication risk. Active disease at the time of dilatation nor medical therapy afterwards predict recurrent dilatation or surgery.

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