Endoscopic small bowel balloon dilations in patients with Crohn's disease:A Danish nationwide cohort study, 1997-2015

Objective Small bowel strictures are a common complication in Crohn's disease. Endoscopic balloon dilation (EBD) is an emerging therapeutic approach that is minimally invasive and helps to preserve the bowel. The aim of this study was to describe the use of EBD in adult Crohn's disease patients with small bowel strictures. Methods This nationwide cohort comprised individuals ≥18 years old, diagnosed with Crohn's disease in Denmark between 1 January 1997 and 31 December 2015, according to the National Patient Registry (NPR). Results The cohort consisted of 9737 incident Crohn's disease patients that were followed for a median of 8.2 years [interquartile range (IQR) = 4.1-13.3]. During the observation period, a total of 90 (1%) patients underwent a small bowel-related EBD. After a follow-up period of a median of 3.4 (IQR = 1.8-5.0) years, primary small bowel strictures treated only with one dilation and no subsequent small bowel surgery accounted for 29 (59%) of 49 cases. A median of 7.2 (IQR = 2.4-13.2) months after their first dilation, 13 (27%) of those 49 patients underwent small bowel surgery. Forty-one patients with postsurgical strictures were dilated after a median of 6.5 (IQR = 2.5-10.2) years following small bowel surgery. Postsurgical strictures treated with only one dilation and no further small bowel surgery accounted for 20 (49%) of the 41 cases. Conclusion The frequency of EBD in this Danish nationwide cohort was low. During a median follow-up of 5 years after EBD, most patients did not require further surgery. This suggests that EBD is an effective treatment and could be offered to more patients with Crohn's disease.