Endoscopic balloon dilation for management of stricturing Crohn's disease in children.
Crohn’s disease
Endoscopic balloon dilation
Endoscopic dilation
Intestinal strictures
Pediatrics
Journal
World journal of gastrointestinal endoscopy
ISSN: 1948-5190
Titre abrégé: World J Gastrointest Endosc
Pays: United States
ID NLM: 101532474
Informations de publication
Date de publication:
16 Sep 2021
16 Sep 2021
Historique:
received:
24
03
2021
revised:
15
06
2021
accepted:
12
08
2021
entrez:
11
10
2021
pubmed:
12
10
2021
medline:
12
10
2021
Statut:
ppublish
Résumé
Crohn's disease (CD) has a multitude of complications including intestinal strictures from fibrostenotic disease. Fibrostenotic disease has been reported in 10%-17% of children at presentation and leads to surgery in 20%-50% of cases within ten years of diagnosis. When symptoms develop from these strictures, the treatment in children has primarily been surgical resection. Endoscopic balloon dilation (EBD) has been shown to be a safe and efficacious alternative to surgery in adults, but evidence is poor in the literature regarding its safety and efficacy in children. To evaluate the outcomes of children with fibrostenosing CD who underwent EBD In a single-center retrospective study, we looked at pediatric patients (ages 0-18) who carry the diagnosis of CD, who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1, 2012 through May 1, 2019. We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype. The type of intervention for patients' strictures was then identified through procedural and surgical billing codes. We evaluated their demographics, clinical variables, whether they underwent EBD Of the 139 patients with CD, 25 (18%) developed strictures. The initial intervention for a stricture was surgical resection in 12 patients (48%) and EBD in 13 patients (52%). However, 4 (33%) patients whom initially had surgical resection required follow up EBD, and thus 17 total patients (68%) underwent EBD at some point in their treatment process. For those 8 patients who underwent successful surgical resection alone, 4 of these patients (50%) had a fistula present near the stricture site and 4 (50%) had strictures greater than 5 cm in length. All patients who underwent EBD had no procedural complications, such as a perforation. Twenty-two (88%) of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period. EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.
Sections du résumé
BACKGROUND
BACKGROUND
Crohn's disease (CD) has a multitude of complications including intestinal strictures from fibrostenotic disease. Fibrostenotic disease has been reported in 10%-17% of children at presentation and leads to surgery in 20%-50% of cases within ten years of diagnosis. When symptoms develop from these strictures, the treatment in children has primarily been surgical resection. Endoscopic balloon dilation (EBD) has been shown to be a safe and efficacious alternative to surgery in adults, but evidence is poor in the literature regarding its safety and efficacy in children.
AIM
OBJECTIVE
To evaluate the outcomes of children with fibrostenosing CD who underwent EBD
METHODS
METHODS
In a single-center retrospective study, we looked at pediatric patients (ages 0-18) who carry the diagnosis of CD, who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1, 2012 through May 1, 2019. We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype. The type of intervention for patients' strictures was then identified through procedural and surgical billing codes. We evaluated their demographics, clinical variables, whether they underwent EBD
RESULTS
RESULTS
Of the 139 patients with CD, 25 (18%) developed strictures. The initial intervention for a stricture was surgical resection in 12 patients (48%) and EBD in 13 patients (52%). However, 4 (33%) patients whom initially had surgical resection required follow up EBD, and thus 17 total patients (68%) underwent EBD at some point in their treatment process. For those 8 patients who underwent successful surgical resection alone, 4 of these patients (50%) had a fistula present near the stricture site and 4 (50%) had strictures greater than 5 cm in length. All patients who underwent EBD had no procedural complications, such as a perforation. Twenty-two (88%) of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period.
CONCLUSION
CONCLUSIONS
EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.
Identifiants
pubmed: 34630888
doi: 10.4253/wjge.v13.i9.382
pmc: PMC8474695
doi:
Types de publication
Journal Article
Langues
eng
Pagination
382-390Informations de copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: The authors report no existing conflict of interest.
Références
J Pediatr Gastroenterol Nutr. 2017 Oct;65(4):475-486
pubmed: 28937552
J Crohns Colitis. 2014 May;8(5):392-400
pubmed: 24189349
Gut. 2010 Mar;59(3):320-4
pubmed: 19840991
Dig Dis Sci. 2009 Jan;54(1):142-50
pubmed: 18594982
Biomolecules. 2019 Nov 26;9(12):
pubmed: 31779136
Front Pediatr. 2017 Jun 16;5:141
pubmed: 28670577
Medicine (Baltimore). 2019 Aug;98(35):e16864
pubmed: 31464914
World J Gastroenterol. 2013 May 7;19(17):2660-7
pubmed: 23674873
United European Gastroenterol J. 2014 Oct;2(5):406-12
pubmed: 25360319
J Pediatr Gastroenterol Nutr. 2018 Sep;67(3):414-430
pubmed: 30130311
J Clin Gastroenterol. 2005 Apr;39(4):284-90
pubmed: 15758621
J Clin Gastroenterol. 2008 Sep;42(8):880-5
pubmed: 18645528
World J Gastroenterol. 2012 Jul 28;18(28):3635-61
pubmed: 22851857
Gastroenterology. 2008 Oct;135(4):1106-13
pubmed: 18692056
Inflamm Bowel Dis. 2017 Jan;23(1):133-142
pubmed: 28002130
Br J Surg. 2000 Dec;87(12):1697-701
pubmed: 11122187
J Crohns Colitis. 2016 Aug;10(8):873-85
pubmed: 26928961
J Crohns Colitis. 2017 Sep 1;11(9):1044-1051
pubmed: 28881875
Aliment Pharmacol Ther. 2012 Jul;36(2):151-8
pubmed: 22612326
Gastrointest Endosc. 2010 Dec;72(6):1201-8
pubmed: 20951986
Inflamm Bowel Dis. 2019 Feb 21;25(3):592-600
pubmed: 30215805
Aliment Pharmacol Ther. 2020 Oct;52(7):1104-1116
pubmed: 32813282