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Publications

Journal Article Multicenter Study Ppublish

PubMed: 40044092 DOI: 10.1016/j.gie.2025.02.036

Risk factors for difficult endoscopic bowel dilation of predominantly shorter and noninflammatory strictures among patients with inflammatory bowel disease: findings from inflammatory bowel disease tertiary centers in Poland and Czech Republic.

Gastrointest Endosc 102(4):571-580

Authors: Konrad Lewandowski, Martin Lukas, Magdalena Kaniewska, Edyta Tulewicz-Marti, Katarzyna Karłowicz, Arkadiusz Bednarczuk, Martin Kolar, Jakub Jirsa, Milan Lukas, Grażyna Rydzewska

Affiliations

  • Department of Gastroenterology and Internal Medicine, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland.
  • IBD Clinical and Research Center, ISCARE a.s. Prague, Czech Republic; Department of Surgery, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic.
  • Department of Gastroenterology and Internal Medicine, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland.
  • IBD Clinical and Research Center, ISCARE a.s. Prague, Czech Republic.
  • Department of Gastroenterology and Internal Medicine, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland; Collegium Medicum, Jan Kochanowski University, Kielce, Poland.

Abstract

BACKGROUND AND AIMS

Intestinal strictures are a common and serious adverse event of inflammatory bowel disease (IBD). Endoscopic balloon dilation (EBD) is the first step in treatment to avoid surgery. The aim of this study was to assess the prevalence, risk factors, and clinical sequelae of difficult EBD.

METHODS

This retrospective, multicenter study included 861 patients with IBD treated with EBD due to strictures. Risk factors for difficult EBD, defined as ≥3 per year, were evaluated.

RESULTS

During a median (IQR) of 23.00 (14.00-42.00) months of follow-up, there were 392 (45.5%) easier EBDs performed, while difficult EBDs were performed in 489 (54.5%) cases. Long-term efficacy of EBD, defined as >12 months without surgery, was achieved in 392 (100%) easier EBDs versus 457 (97.4%) difficult EBDs (Cramer's V = .11; P = .004). However, 149 (17.3%) patients underwent surgery for unsuccessful EBD. The most important risk factors for difficult EBD, classified as modifiable, were smoking and treatment with adalimumab (especially if trough levels were normal) and ustekinumab. Vedolizumab and immunosuppressive therapy were identified as protective factors. Multivariable logistic regression analysis indicated good fit of the model to the data, pointing to a protective role for total parental nutrition and worsening of smoking (both, P < .001).

CONCLUSIONS

Reduction of difficult EBDs should be considered primarily in the context of their modifiable risk factors. Prospective studies with simultaneous evaluation of transmural healing are needed to truly assess whether vedolizumab treatment, immunosuppressive therapy, and total parenteral nutrition reduce the risk of EBD.

MeSH

Constriction, Pathologic, Gastroenterology, Endoscopy, Inflammatory Bowel Diseases, Risk Factors, Therapeutics, Immunosuppression Therapy, Smoking