Evaluation of the endoscopic treatment with topical prednisolone administration for intestinal strictures in Crohn’s disease

Abstract

Introduction: The prevalence of Crohn’s disease amounts to 5.9 cases per 100,000 population. Complications such as intestinal strictures usually occur within a long course of Crohn’s disease. Intestinal resection for stricture does not prevent a stricture recurrence and the need for repeated resections, which in turn leads to the formation of short intestine syndrome. The advantage of endoscopic balloon dilatation is organ preservation and a quick clinical therapeutic effiect. However, the frequency of recurrences after conventional endoscopic balloon dilatation of the intestinal stricture in Crohn’s disease is still at a relatively high level and amounts to 59%, which justifies the need to improve the endoscopic dilatation technique. Aim: The aim of this study to improve the treatment effectiveness for intestinal strictures in Crohn’s disease using endoscopic balloon dilatation combined with prednisolone injection in the stricture area. Materials and methods: Endoscopic treatment for intestinal strictures in Crohn’s disease was performed in 64 patients. Depending on the endoscopic technique, patients were randomized into 2 groups. The first group consisted of 32 (50%) patients who underwent conventional endoscopic balloon dilatation of strictured areas. The second group consisted of 32 (50%) patients in whom an endoscopic balloon dilatation in combination with submucosal injection of prednisolone to the area of stricture after dilatation was performed. Patient groups were comparable in age, sex and length of stricture. Results and conclusions: The results showed that endoscopic balloon dilatation with administration of 40 mg of prednisolone in group II patients was more effective compared to conventional balloon dilatation. The recurrence rate was reduced from 34.4% to 9.3%. The risk of recurrence of intestinal stricture in group I during the first year of observation was found to be 4.5 times higher – HR = 4.5 (1.6–12.9); P = 0.010. The effectiveness of advanced endoscopic balloon dilatation for intestinal strictures was confirmed by colonoscopy with patomorphological examination of the intestinal mucosa 6 months after dilation in patients of both groups.