Comparison of endoscopic balloon dilation and surgery for duodenal stricture in patients with Crohn's disease

• Published in: Scandinavian journal of gastroenterology Vol. 59; no. 1; p. 39
• Main Authors: Chen, Yusheng, Sun, Zhenya, Li, Zhun, Duan, Ming, Zhou, Yan, Li, Yi, Zhu, Weiming, Guo, Zhen
• Format: Journal Article
• Language: English
• Published: England 2024
• Subjects: endoscopic balloon dilation; duodenal stricture; outcome; Crohn’s disease; surgery
• ISSN: 1502-7708
• DOI: 10.1080/00365521.2023.2250495

Few studies have compared endoscopic balloon dilation (EBD) and surgery in the treatment of duodenal stricture in patients with Crohn's disease (CD). We performed a retrospective study to compare the efficacy and safety among patients with CD-associated duodenal stricture treated with EBD or surgery from October 2013 to December 2021. Univariate and multivariate analyses were performed to evaluate factors associated with recurrence-free or surgery-free survival. A total of 48 eligible patients were included, including 30 patients treated with EBD only and 18 patients treated with surgery. Patients treated with surgery experienced more symptomatic improvement (100% vs. 63.33%,  = 0.003) and significantly longer recurrence-free survival (6.31 [IQR: 3.00-8.39] years vs. 2.96 [IQR: 1.06-5.42] years,  = 0.01) but suffered more postprocedural adverse events (16.67% vs. 0.74% per procedure,  = 0.001). In patients initially treated with EBD (  = 41), a total of 11 (26.83%) required subsequent surgical intervention. Younger age at CD diagnosis (HR = 0.90, 95% CI: 0.81-1.00,  = 0.04) was associated with a higher risk for subsequent surgery. Surgery for CD-associated duodenal strictures was associated with a longer recurrence-free survival. EBD was safe and effective with minimal postprocedural adverse events but led to a high frequency of recurrence.