2016 Volume 89 Issue 1 Pages 45-49
Background : Several reports showed that endoscopic balloon dilatation is efficacious for intestinal stenosis in Crohn’s disease (CD) . Recurrent stenosis, however, is not infrequent. Aim : Factors to affect the outcome after endoscopic of balloon dilatation for intestinal stenosis in patients with CD patients are assessed. Data Source : Comparative cohort studies about endoscopic dilatation for stenosis due to CD are collected through searching PubMed and Igaku-Chuo-Zasshi, a Japanese database, until August 2016. Study Selection : Studies to investigate the efficacy of endoscopic balloon dilatation as a primary outcome were selected. Data Extraction : All data evaluations and inclusion decisions were performed by investigators. Data Synthesis : Extracted data were collected into a structured database, and hazard ratio (HR) was examined using surgery rate as an outcome in case control studies. If HR was not shown, Tierney’s method was applied. Results : Eight studies met the inclusion criteria, and HR for surgery free survival after balloon dilatation was synthesized with meta-analysis. Three studies (n＝240) for anastomotic stenosis did not show clinical benefit as compared to stenosis of de novo as evidenced in HR (0.77 ; 95% CI 0.44-1.37) . Two small trials (n＝56) comparing a group with thiopurine therapy after balloon dilatation with no thiopurine group showed no benefit of thiopurine therapy (HR 0.61 ; 95% CI 0.16-2.36) . Also no difference was found concerning steroid injection into the stenotic lesion (HR 6.1 ; 95% CI 0.70-53.0) . One trial comparing smokers to non-smokers after balloon dilatation showed difference (HR 2.5 ; 95% CI 1.14-5.50) . Limitation : The eligible studies involved relatively small number of subjects and suffer from relatively high risk of bias. Conclusion : Prognosis was not affected by the nature of stenosis (de novo or anastomotic) or use of thiopurine. Surgery may be avoided by smoking cessation.
