EFFICACY AND SAFETY OF HYDROSTATIC BALLOON DILATATION OF ILEOCOLONIC CROHNS STRICTURES - A PROSPECTIVE LONG-TERM ANALYSIS

Preliminary reports have suggested that dilatation using hydrostatic t hrough the scope balloons may be useful for the treatment of Crohn's s trictures, A prospective longterm follow up (mean (SD) 33.6 (11.2) mon ths) was carried out in 55 Crohn's patients with 59 ileocolonic strict ures submitted to 78 dilatation procedures. Hydrostatic balloons were used (Rigiflator, Microvasive) with a diameter of 18 mm on inflation. As soon as the baboons became available dilatation up to a diameter of 20 and 25 mm was attempted. The dilatations were performed under gene ral anaesthesia using propofol (Diprivan). The patients were kept for one night in the hospital after dilatation. Seventy (90%) procedures w ere technically successful and passage of the stricture with a 13.6 mm diameter colonoscope was possible after 73% of the dilatations. Compl ications occurred in six patients (11%; 8% of procedures), including s ealed perforations (n=2), retroperitoneal perforations (n=2), and intr aperitoneal perforations (n=2). Two of the patients were treated surgi cally with a one stage resection of the stricture and recovered uneven tfully. Four patients were treated conservatively with intravenous flu ids and antibiotics. There was no mortality. Dilatation completely rel ieved obstructive symptoms in 20 patients after one procedure, in anot her 14 patients after two (n=13) or three (n=1) dilatations. Total lon gterm success rate was 34 of 55 patients (62%). Nineteen patients (38% ) were operated on because of persistent obstructive symptoms. The dat a show that endoscopic dilatation using the through the scope hydrosta tic balloon system relieves obstructive symptoms resulting from ileoco lonic Crohn's strictures. The procedure, however, carries a definite r isk of perforation.