Heterogeneity in endoscopic treatment of Crohn’s disease-associated strictures: An international inflammatory bowel disease specialist survey

• Published in: Journal of gastroenterology Vol. 51; no. 10; pp. 939 - 948
• Main Authors: Bettenworth, Dominik, Lopez, Rocio, Hindryckx, Pieter, Levesque, Barrett G., Rieder, Florian
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.10.2016; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Cecal Diseases - etiology; Cecal Diseases - pathology; Cecal Diseases - surgery; Cecal Diseases - therapy; Clinical Competence; Colitis; Colorectal Surgery; Constriction, Pathologic - etiology; Constriction, Pathologic - pathology; Constriction, Pathologic - therapy; Crohn Disease - complications; Dilatation; Drug therapy; Endoscopy; Endoscopy, Gastrointestinal; Europe; Gastroenterology; Hepatology; Hospitals, Community; Hospitals, Teaching; Humans; Ileal Diseases - etiology; Ileal Diseases - pathology; Ileal Diseases - surgery; Ileal Diseases - therapy; Inflammatory bowel disease; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; North America; Original Article—Alimentary Tract; Practice Patterns, Physicians; Private Practice; Professional Practice Location; Specialties, Surgical; Surgical Oncology; Surveys; Surveys and Questionnaires; Balloon dilation; Intestinal stricture; Crohn’s disease
• ISSN: 0944-1174; 1435-5922; 1435-5922
• DOI: 10.1007/s00535-016-1172-6

Background Crohn’s disease (CD) is frequently complicated by intestinal strictures, which are commonly treated by endoscopic balloon dilation (EBD). However, available data on this area of treatment is limited. The aim of this study was to depict the heterogeneity of endoscopic management of CD-associated strictures among international CD specialists to identify common treatment standards. Methods IBD experts of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD), the European Crohn’s and Colitis Organization (ECCO), and from the Prospective Value In IBD trials (PROVIT) completed a web-based questionnaire to evaluate their endoscopic experience, practice setting, and number of EBDs performed annually. Additionally, two case scenarios and technical practice parameters were investigated. Results A total of 126 subjects from 15 countries completed the survey. The maximal length of dilated stricture was 4.5 ± 1.7 cm. The most commonly used maximal balloon size was graded as 15–18 mm. While 87.2 % of the participants favored EBD for anastomotic strictures, only 58.6 % did so in the case of naïve strictures. Only 35.7 % of physicians dilated actively inflamed strictures. Interventional endoscopists were more likely to dilate only clinically symptomatic strictures ( p  = 0.046). Surgeons favored surgical treatment of de novo ileocecal strictures compared to gastroenterologists ( p  = 0.026), reported a shorter stricture length being amendable by EBD ( p  = 0.045), and more frequently used concomitant therapies ( p  = 0.001). Operator experience increased the likelihood of EBD use in actively inflamed strictures ( p  = 0.002), maximum length of stricture, and maximum balloon size ( p  = 0.001). Conclusions EBD is a widely used treatment approach for stricturing CD. Individual approaches differ significantly based on background of the operator, experience level, and practice setting.