Endoscopic treatment of Crohn-related strictures with a self-expandable stent compared with balloon dilation: a prospective, randomised, controlled study. Issue 1 (15th March 2021)

• Record Type: Journal Article
• Authors: Hedenström, Per; Stotzer, Per-Ove
• Is Part Of: BMJ open gastroenterology. Volume 8:Issue 1(2021)
• Publication Date: 2021-03-15
• Subjects: fibrosis -- endoscopy -- stents -- crohn's disease; Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1136/bmjgast-2021-000612
• Languages: English
• ISSNs: 2054-4774

Abstract

Abstract : Objective: Fibrotic strictures in the gastrointestinal tract are frequent in Crohn's disease. Endoscopic dilation is a standard treatment. However, recurrence is common after dilation and there are complications such as bleeding or perforation. Endoscopic treatment using self-expandable metal stents has shown diverging results. The aim of this study was to evaluate the outcome of endoscopic treatment with a self-expandable stent in ileocecal Crohn's disease. Design/method: Patients with Crohn's disease and a symptomatic ileocecal stricture were eligible for prospective, consecutive inclusion in a single-centre setting. Patients were randomised to treatment with either 18 mm balloon dilatation (GroupDIL ) or stenting (GroupSTENT ) using a 20 mm diameter, partially covered Hanarostent NCN. Patients were followed for a minimum of 24 months postendoscopy. Outcomes were technical success, adverse events and clinical success (defined as no need for repeated interventions). Results: Thirteen patients (GroupDIL n=6; GroupSTENT =7) were included with twelve patients (GroupDIL n=5; GroupSTENT =7) being eligible for complete follow-up. Technical success was achieved in all cases. Adverse events were border-line significantly more common in the GroupSTENT : 4/7 (57%) (pain: n=3; pain and rectal bleeding: n=1) compared with the GroupDIL : 0/5 (0%), p=0.08, which resulted in preterm termination of the study. The clinical success rate was GroupSTENT : 6/7 (86%) vs GroupDIL : 1/5 (20%), p=0.07. Conclusion: Patients with strictures related to Crohn's disease may benefit from treatment with self-expandable metal stents rather than dilatation. However, there seems to be an increased risk for patient pain after stenting, which has to be considered and handled. Trail registration number: The study was registered at Clinical Trials (NCT04718493 ).