Endoscopic Stricturotomy Versus Balloon Dilation in the Treatment of Anastomotic Strictures in Crohn's Disease

Background: Current treatment modalities for anastomotic stricture in Crohn's disease (CD) include endoscopic balloon dilation (EBD) and surgery. We recently published a case series of inflammatory bowel disease patients treated with the novel endoscopic stricturotomy (ES). The aim of this case-control study was to compare the efficacy and safety of ES versus conventional EBD in the treatment of anastomotic strictures in CD patients. Methods: All eligible patients with CD anastomotic stricture who were treated with ES or EBD were included. The primary outcomes were surgery-free survival and post-procedural complications. Results: A total of 185 patients were studied, including 21 treated with ES since 2009, and 164 treated with EBD since 1998. The immediate technical success after therapy was achieved in 100% of patients treated with ES and 89.5% of patients with EBD. Symptomatic and endoscopic improvement rates were higher in those treated with ES than EBD. Subsequent surgery was needed in 2 (9.5%) patients with ES and 55 (33.5%) with EBD (P = 0.03), during a median of 0.8 (interquartile range [IQR]: 0.1-1.6) year and 4.0 (IQR: 0.8-6.9) years, respectively. Five procedure-associated perforation (1.1% per procedure) occurred in the EBD group and none in the ES group. In contrast, 4 procedure-associated, transfusion-required bleeding (8.8% per procedure) occurred in the ES group and none in the EBD group. Conclusions: ES appears to be more effective in treating CD patients with anastomotic stricture than EBD. Although ES may have a lower risk for perforation, the procedure needs to be perfected to reduce its bleeding risk.