Outcomes of endoscopic balloon dilatation for de novo and anastomotic Crohn’s strictures: a Canadian tertiary center experience

Abstract

Abstract Background Over half of patients with Crohn’s disease (CD) develop intestinal strictures that often require surgical resection. Endoscopic balloon dilatation (EBD) can be a potential alternative therapeutic option. Methods This retrospective cohort study included adult patients with CD (≥18 years) who underwent EBD between January 2016 and September 2024 at two Canadian hospitals. The primary outcome was technical success. Secondary outcomes were clinical success at 6 and 12 months, hospitalization due to obstruction, and CD-related surgery. Cox proportional hazards models assessed predictors of outcomes. Results A total of 234 patients (age: 47.6 years, males: 47.4%) were included with mean disease duration of 17.7 years and median follow-up of 61 months. A majority of the strictures (226/234) were dilated under ileocolonoscopy guidance, and 79.4% had symptoms at baseline. Most strictures were of de novo type (62.5%) and the median number of stricture dilatations was 3 (IQR: 2). Technical success was achieved in 81% (150/185). Clinical success was noted in 47.7% at 6 months. The cumulative probabilities of being hospitalization-free were 96.9% (95% CI 94.7-99.2]) at 1 year, 91.3% (95% CI 87.5-95.2) at 3 years, and 85.0% (95% CI 79.8-90.5) at 5 years. The cumulative probabilities of being surgery-free were 91.1% (95% CI 87.5-94.9) at 1 year, 81.7% (95% CI 76.5-87.2) at 3 years, and 78.1% (95% CI 72.4-84.3) at 5 years. Multiple strictures were associated with an increased risk of surgery while anastomotic strictures and maximum balloon diameter were associated with lower risk. No patients experienced procedure-related complications. Conclusions EBD is effective and safe in de novo and anastomotic strictures with the majority of patients achieving technical success and being free of surgery within 5 years.