Endoscopic Therapy Opens Strictures in IBD Children

A new study reports that endoscopic balloon therapy can successfully dilate strictures in the gastrointestinal (GI) tract in children caused by consequences of inflammatory bowel disease (IBD), thus avoiding or delaying surgery.

Researchers at the University of California, San Francisco (UCSF; Fresno, USA) conducted a prospective pilot study to evaluate the use of endoscopic balloon dilation plus intramural corticosteroid injection in 12 patients (median age 14.5 years), 8 of whom were boys. The 12 patients had 13 strictures: One in the esophagus, one in the antrum, four in the right colon and seven in the ileum. Overall, the 12 patients were treated with 15 dilatation procedures.

The results showed that nine of the children required just a single procedure; two children needed a second endoscopic procedure, and one child eventually required surgery to maintain the opening of the strictures. Of the 12 children, 11 (92%) have not required further treatment. The children that underwent a re-dilatation when their symptoms returned and imaging showed that the strictures had narrowed. The procedure has already been performed on another 15 children, but they have not yet reached the one-year milestone. The study was presented at Digestive Disease Week (DDW), held during May 2014 in Chicago (IL, USA).

“We have not had any endoscopic-related complications; we have had no perforations. There is always some bleeding when you dilate any stricture—it is something you want to see because it indicates you are dilating the stricture. But we have had no major bleeding incidents,” said lead author and study presenter assistant professor of pediatric gastroenterology Roberto Gugig, MD. “If we can prevent surgery for a year or 3 years or 5 years, then maybe we are having an impact on the natural history of the disease. We might be able to change the statistics. That's my goal.”

The endoscopic balloon technique, which takes about 20–40 minutes, is similar to angioplasty in the arteries, but uses a larger balloon which is filled with water and a contrast agent to assess how well the dilatation is proceeding. According to the researchers, the procedure appears to work better when there is active inflammation when the endoscopy is performed.

Related Links:
University of California, San Francisco (Fresno)