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

Abstract

Background

Few studies have compared endoscopic balloon dilation (EBD) and surgery in the treatment of duodenal stricture in patients with Crohn’s disease (CD).

Methods

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.

Results

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%, p = 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, p = 0.01) but suffered more postprocedural adverse events (16.67% vs. 0.74% per procedure, p = 0.001). In patients initially treated with EBD (n = 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, p = 0.04) was associated with a higher risk for subsequent surgery.

Conclusions

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.

Keywords:

• Crohn’s disease
• duodenal stricture
• endoscopic balloon dilation
• surgery
• outcome

Acknowledgments

This work was supported by grants from the Project of Jiangsu Provincial Health Commission (M2021013) and Scientific Research and the Science Foundation of Jinling Hospital (YYMS2021035). The study was approved by the Ethic Committee of Jinling Hospital.

Author contributions

Yusheng Chen: Conceptualization; Methodology; Investigation; Formal Analysis; Writing—original draft; Zhenya Sun: Methodology; Formal Analysis; Writing—review and editing; Zhun Li: Methodology; Formal Analysis; Writing—review and editing; Ming Duan: Investigation; Formal Analysis; Writing—review and editing; Yan Zhou: Data Curation; Investigation; Writing—review and editing; Yi Li: Conceptualization; Formal Analysis; Writing—review and editing; Weiming Zhu: Supervision; Conceptualization; Writing—review and editing; Zhen Guo: Supervision; Conceptualization; Writing—review and editing.

Disclosure statement of interest

The authors declared no conflict of interest.

Data availability statement

The dataset(s) used or analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the Project of Jiangsu Provincial Health Commission (M2021013) and Scientific Research and the Science Foundation of Jinling Hospital (YYMS2021035).