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Efficacy and safety of endoscopic balloon dilation in inflammatory bowel disease: results of the large multicenter study of the ENEIDA registry

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A Correction to this article was published on 18 June 2019

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Abstract

Background

There is no information regarding the outcome of Crohn’s disease (CD) patients treated with endoscopic balloon dilation (EBD) in non-referral hospitals, nor on the efficacy of EBD in ulcerative colitis (UC). We report herein the results of the largest series published to date.

Aim

To assess the efficacy and safety of EBD for inflammatory bowel disease (IBD) stenosis performed in 19 hospitals with different levels of complexity and to determine factors related to therapeutic success.

Methods

We identified IBD patients undergoing EBD in the ENEIDA database. Efficacy of EBD was compared between CD and UC and between secondary and tertiary hospitals. Predictive factors of therapeutic success were assessed with multivariate analysis.

Results

Four-hundred dilations (41.2% anastomotic) were performed in 187 IBD patients (13 UC/Indeterminate colitis). Technical and therapeutic success per dilation was achieved in 79.5% and 55.3%, respectively. Therapeutic success per patient was achieved in 78.1% of cases (median follow-up: 40 months) with 49.7% requiring more than one dilation. No differences related to either diagnosis or hospital complexity was found. Technical success [OR 4.12 (95%CI 2.4–7.1)] and not receiving anti-TNF at the time of dilation [OR 1.7 (95% CI 1.1–2.6)] were independently related to therapeutic success per dilation. A stricture length ≤ 2 cm [HR 2.43 (95% CI 1.11–5.31)] was a predictive factor of long-term success per patient. The rate of major complications was 1.3%.

Conclusions

EBD can be performed with similar efficacy and safety in hospitals with differing levels of complexity and it might be a suitable treatment for UC with short stenosis. To achieve a technical success and the short length of the stenosis seem to be critical for long-term therapeutic success.

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Change history

  • 18 June 2019

    Javier P. Gisbert was listed incorrectly as Javier Pérez-Gisbert.

Abbreviations

ASGE:

The American Society for Gastrointestinal Endoscopy

CD:

Crohn’s disease

COMBO:

Combined treatment (immunosuppressant plus biological treatment)

EBD:

Endoscopic balloon dilation

ENEIDA:

Estudio Nacional en Enfermedad Inflamatoria Intestinal sobre Determinantes genéticos y Ambientales (Spanish Study of Genetic and Environmental Determinants in Inflammatory Bowel Disease)

GETECCU:

Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (The Spanish Working Group in Crohn’s Disease and Colitis)

IBD:

Inflammatory bowel disease

IC:

Indeterminate colitis

IFX:

Infliximab

IMM:

Immunosuppressant’s alone

IPAA:

Ileal pouch-anal anastomosis

TNF:

Tumour Necrosis Factor

UC:

Ulcerative colitis

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Acknowledgements

On the behalf of the ENEIDA registry of GETECCU (in addition to the authors): Julià Panés, MD PhD (Hospital Clínic de Barcelona, Barcelona), Míguel Mínguez, MD PhD (Hospital Clínico de Valencia, Valencia), Valle García Sánchez, MD PhD (Hospital Reina Sofía, Córdoba), Javier Pérez-Gisbert, MD PhD (Hospital La Princesa, Madrid), Fernando Gomollón, MD PhD (Hospital Lozano Blesa, Zaragoza), Marta Piqueras, MD (Consorci Sanitari de Terrassa, Barcelona), José Luís Cabriada, MD PhD (Hospital de Galdakao, Bizkaia), Montserrat Andreu, MD PhD (Hospital del Mar, Barcelona).

Author information

Author notes

  1. Xavier Andújar and Carme Loras have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Endoscopy Unit, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Plaça Dr Robert nº 5, Terrassa, 08221, Barcelona, Catalonia, Spain

    Xavier Andújar, Carme Loras, Yamile Zabana, Fernando Fernández-Bañares, María Esteve & Julià Panés

  2. Hospital Clínic de Barcelona, Barcelona, Spain

    Begoña González & Milena Socarras

  3. Hospital Clínico Universitario de Valencia, Valencia, Spain

    Vicente Sanchiz & Maia Boscà

  4. Hospital Germans Trias i Pujol, Barcelona, Spain

    Eugeni Domenech & Margalida Calafat

  5. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz De Tenerife, Spain

    Esther Rodríguez

  6. Complejo Asistencial Universitario de Burgos, Burgos, Spain

    Beatriz Sicilia

  7. Corporació Sanitària Universitària Parc Taulí, Barcelona, Spain

    Xavier Calvet

  8. Hospital Rio Hortega, León, Spain

    Jesús Barrio

  9. Hospital Universitari de Bellvitge, Barcelona, Spain

    Jordi Guardiola

  10. Hospital Universitario Reina Sofía, Córdoba, Spain

    Eva Iglesias

  11. Hospital Universitario de La Princesa, Madrid, Spain

    María José Casanova

  12. Hospital Lozano Blesa, Zaragoza, Spain

    Yolanda Ber

  13. Consorci Sanitari de Terrassa, Barcelona, Spain

    David Monfort

  14. Hospital Universitario Ramón y Cajal, Madrid, Spain

    Antonio López-Sanromán

  15. Hospital de Galdakao, Bizkaia, Spain

    Iago Rodríguez-Lago

  16. Hospital Universitario Donostia/Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), Gipuzkua, Spain

    Luís Bujanda

  17. Hospital del Mar, Barcelona, Spain

    Lucía Márquez

  18. Hospital La Paz, Madrid, Spain

    María Dolores Martín-Arranz

  19. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

    Xavier Andújar, Carme Loras, Begoña González, Milena Socarras, Xavier Calvet, María José Casanova, Luís Bujanda, Yamile Zabana, Fernando Fernández-Bañares & María Esteve

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  1. Xavier Andújar
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  2. Carme Loras
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Consortia

the ENEIDA registry of GETECCU

  • Julià Panés
  • , Míguel Mínguez
  • , Valle García Sánchez
  • , Javier Pérez-Gisbert
  • , Fernando Gomollón
  • , Marta Piqueras
  • , José Luís Cabriada
  •  & Montserrat Andreu

Contributions

CL: design of the study, study coordination, acquisition of data, statistical analysis and interpretation of data, manuscript writing, critical revision of the manuscript, and approval of the final draft submitted. XA: study coordination, acquisition of data, statistical analysis and interpretation of data, manuscript writing, critical revision of the manuscript, and approval of the final draft submitted. ME: design of the study, study coordination, critical revision of the manuscript, and approval of the final draft submitted. FFB, YZ: statistical analysis and interpretation of data, critical revision of the manuscript, and approval of the final draft submitted. BG, MS, VS, MB, ED, MC, ER, BS, XC, JB, JG, EI, JPG, MJC, YB, DM, ALS, IR, LB, MA, LM, MDM: acquisition of data, approval of the final draft submitted.

Corresponding author

Correspondence to Carme Loras.

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Disclosures

Xavier Andújar, Carme Loras, Begoña González, Milena Socarras, Vicente, Maia Boscà, Eugeni Domenech, Margalida Calafat, Esther Rodríguez, Beatriz Sicilia, Xavier Calvet, Jesús Barrio, Jordi Guardiola, Eva Iglesias, María José Casanova, Yolanda Ber, David Monfort, Antonio López-Sanromán, Iago Rodríguez, Luís Bujanda, Lucía Márquez, María Dolores Martín-Arranz, Yamile Zabana, Fernando Fernández-Bañares and María Esteve have no conflict of interest or financial ties to disclose.

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The members of the ENEIDA registry of GETECCU are listed in the “Acknowledgement” section.

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Andújar, X., Loras, C., González, B. et al. Efficacy and safety of endoscopic balloon dilation in inflammatory bowel disease: results of the large multicenter study of the ENEIDA registry. Surg Endosc 34, 1112–1122 (2020). https://doi.org/10.1007/s00464-019-06858-z

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