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

  • Original Article—Alimentary Tract
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Abstract

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.

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Abbreviations

EBD:

Endoscopic balloon dilatation

SP:

Strictureplasty

TNF-α:

Tumor necrosis factor-alpha

CD:

Crohn’s disease

TTS:

Through-the-scope

psi:

Pounds per square inch

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Acknowledgments

This work was supported by a research fellowship from the Faculty of Medicine, Westfälische Wilhelms-Universität Münster, awarded to D.B. This work was supported by grants from the National Institutes of Health (1T32DK083251) and the European Crohn’s and Colitis Foundation, awarded to F.R.

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    Authors and Affiliations

    1. Department of Medicine B, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany

      Dominik Bettenworth

    2. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

      Rocio Lopez

    3. Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium

      Pieter Hindryckx

    4. Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA

      Barrett G. Levesque

    5. Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

      Florian Rieder

    6. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

      Florian Rieder

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    1. Dominik Bettenworth
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    Correspondence to Dominik Bettenworth.

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    D. Bettenworth and F. Rieder both contributed equally to this manuscript.

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    Bettenworth, D., Lopez, R., Hindryckx, P. et al. Heterogeneity in endoscopic treatment of Crohn’s disease-associated strictures: An international inflammatory bowel disease specialist survey. J Gastroenterol 51, 939–948 (2016). https://doi.org/10.1007/s00535-016-1172-6

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