Endoscopic balloon dilation vs. strictureplasty in the treatment of naive strictures in Crohn's Disease patients

Problem: Obstructing strictures occurring in Crohn's are due to failure of medical management to prevent progression the disease. Although resection has been the traditional surgical approach, strictureplasty has become the modern choice of surgical intervention with lower complication rates and low surgical reoperation. An alternative outpatient procedure, Endoscopic Balloon Dilatation has been performed over the last two decades with similar outcomes. EBD is a safe alternative to surgery and postpones the need for surgery in patients with disease flare-up. Methods: A two-step approach was implemented. First, a PubMed search regarding endoscopic balloon dilatation in Crohn's disease was performed. Studies were included with the following criteria: 1) publish date after 2000, 2) greater than 14 subjects, and 3) original study. Second, references of found matching articles were scanned and cross-referenced with original search results and included based on relevance. Twenty-three articles were originally found, twelve were excluded, and seven articles were added. Results: Of the eighteen studies, three were prospective studies. The remaining fifteen were single-center cohort retrospective studies. The number of subjects varied from 14 to 138. Complication rates were 0 to 25 percent. The need for surgical intervention varied from 0 to 59 percent over a follow up period ranging from 1.5 to 7.2 years. Technical success varied from 76 to 96.5 percent. Conclusions: Endoscopic balloon dilatation is a safe alternative to surgical intervention with low complication and re-operative rates among post-operative patients experiencing strictures, particular at the site of anastomosis. However, very little data exists on prospective analyses of the procedure with virtually no long-term follow up results. Further investigation is warranted, comparing EBD to strictureplasty in Crohn's Disease-related strictures.