Endoscopic dilation of small-intestine strictures in Crohn’s disease by balloon-assisted enteroscopy: a systematic review and meta-analysis

Abstract

Background Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn’s disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD.

Methods We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the randomeffects model, and heterogeneity was studied using I2 statistics.

Results We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; I2=53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; I2=71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; I2=57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; I2=28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; I2=3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; I2=59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; I2=85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; I2=44%].

Conclusion BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery.

Keywords Crohn’s disease, endoscopic dilation, balloon-assisted enteroscopy, stricture

Ann Gastroenterol 2024; 37 (6): 682-694