Long‐term outcomes of endoscopic balloon dilation for intestinal strictures in patients with Crohn's disease during maintenance treatment with anti‐tumor necrosis factor alpha antibodies
Background and aims Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn’s disease (CD) receiving anti‐tumor necrosis factor alpha antibodies (anti‐TNF) as maintenance therapy is unclear. We investigated the long‐term efficacy and safety of EBD for intestina...
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| Veröffentlicht in: | Digestive endoscopy 2022-03, Vol.34 (3), p.517-525 |
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| creator | Takeda, Teruyuki Kishi, Masahiro Takatsu, Noritaka Takada, Yasumichi Beppu, Tsuyoshi Miyaoka, Masaki Hisabe, Takashi Ueki, Toshiharu Arima, Hisatomi Hirai, Fumihito Yao, Kenshi |
| description | Background and aims
Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn’s disease (CD) receiving anti‐tumor necrosis factor alpha antibodies (anti‐TNF) as maintenance therapy is unclear. We investigated the long‐term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti‐TNF.
Methods
We retrospectively analyzed data from patients with CD who received anti‐TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥6 months. The primary endpoint was the cumulative surgery‐free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety.
Results
Seventy‐two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3‐ and 5‐year cumulative surgery‐free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36–10.01; P = 0.011). Serious complications requiring surgery developed in three patients.
Conclusions
Endoscopic balloon dilation was an effective and safe short‐term treatment and a useful long‐term treatment for CD patients with intestinal strictures receiving anti‐TNF as maintenance therapy. |
| doi_str_mv | 10.1111/den.14073 |
| format | Article |
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Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn’s disease (CD) receiving anti‐tumor necrosis factor alpha antibodies (anti‐TNF) as maintenance therapy is unclear. We investigated the long‐term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti‐TNF.
Methods
We retrospectively analyzed data from patients with CD who received anti‐TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥6 months. The primary endpoint was the cumulative surgery‐free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety.
Results
Seventy‐two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3‐ and 5‐year cumulative surgery‐free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36–10.01; P = 0.011). Serious complications requiring surgery developed in three patients.
Conclusions
Endoscopic balloon dilation was an effective and safe short‐term treatment and a useful long‐term treatment for CD patients with intestinal strictures receiving anti‐TNF as maintenance therapy.</description><identifier>ISSN: 0915-5635</identifier><identifier>EISSN: 1443-1661</identifier><identifier>DOI: 10.1111/den.14073</identifier><identifier>PMID: 34185921</identifier><language>eng</language><publisher>Australia</publisher><subject>Constriction, Pathologic - complications ; Crohn Disease - complications ; Crohn Disease - pathology ; Crohn’s disease ; Dilatation - adverse effects ; dilation ; endoscopy ; Endoscopy, Gastrointestinal - adverse effects ; Humans ; Intestinal Obstruction - etiology ; Retrospective Studies ; stricture ; TNF‐α inhibitor ; Treatment Outcome ; Tumor Necrosis Factor Inhibitors</subject><ispartof>Digestive endoscopy, 2022-03, Vol.34 (3), p.517-525</ispartof><rights>2021 Japan Gastroenterological Endoscopy Society</rights><rights>2021 Japan Gastroenterological Endoscopy Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3493-a17c26fd2111b1a6d657ea37275a19ec7f422d931dfe0df90829de2e495fa6dc3</citedby><cites>FETCH-LOGICAL-c3493-a17c26fd2111b1a6d657ea37275a19ec7f422d931dfe0df90829de2e495fa6dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fden.14073$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fden.14073$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34185921$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Takeda, Teruyuki</creatorcontrib><creatorcontrib>Kishi, Masahiro</creatorcontrib><creatorcontrib>Takatsu, Noritaka</creatorcontrib><creatorcontrib>Takada, Yasumichi</creatorcontrib><creatorcontrib>Beppu, Tsuyoshi</creatorcontrib><creatorcontrib>Miyaoka, Masaki</creatorcontrib><creatorcontrib>Hisabe, Takashi</creatorcontrib><creatorcontrib>Ueki, Toshiharu</creatorcontrib><creatorcontrib>Arima, Hisatomi</creatorcontrib><creatorcontrib>Hirai, Fumihito</creatorcontrib><creatorcontrib>Yao, Kenshi</creatorcontrib><title>Long‐term outcomes of endoscopic balloon dilation for intestinal strictures in patients with Crohn's disease during maintenance treatment with anti‐tumor necrosis factor alpha antibodies</title><title>Digestive endoscopy</title><addtitle>Dig Endosc</addtitle><description>Background and aims
Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn’s disease (CD) receiving anti‐tumor necrosis factor alpha antibodies (anti‐TNF) as maintenance therapy is unclear. We investigated the long‐term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti‐TNF.
Methods
We retrospectively analyzed data from patients with CD who received anti‐TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥6 months. The primary endpoint was the cumulative surgery‐free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety.
Results
Seventy‐two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3‐ and 5‐year cumulative surgery‐free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36–10.01; P = 0.011). Serious complications requiring surgery developed in three patients.
Conclusions
Endoscopic balloon dilation was an effective and safe short‐term treatment and a useful long‐term treatment for CD patients with intestinal strictures receiving anti‐TNF as maintenance therapy.</description><subject>Constriction, Pathologic - complications</subject><subject>Crohn Disease - complications</subject><subject>Crohn Disease - pathology</subject><subject>Crohn’s disease</subject><subject>Dilatation - adverse effects</subject><subject>dilation</subject><subject>endoscopy</subject><subject>Endoscopy, Gastrointestinal - adverse effects</subject><subject>Humans</subject><subject>Intestinal Obstruction - etiology</subject><subject>Retrospective Studies</subject><subject>stricture</subject><subject>TNF‐α inhibitor</subject><subject>Treatment Outcome</subject><subject>Tumor Necrosis Factor Inhibitors</subject><issn>0915-5635</issn><issn>1443-1661</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1uFDEQhS0EIpPAggsg7yCLTvzX3fESDeFHGsEG1q0au5wx6rYb260oO47AiTgMJ8GTDuzwpmzpe6_K9Qh5wdkFr-fSYrjgivXyEdlwpWTDu44_Jhumedu0nWxPyGnO3xjjQiv1lJxIxa9aLfiG_NrFcPP7x8-CaaJxKSZOmGl0FION2cTZG7qHcYwxUOtHKL5eXEzUh4K5-AAjzSV5U5ZUhT7QuTIYSqa3vhzoNsVDeJWrNiNkpHZJPtzQCY76AMEgLQmhTFWyKiAUfxxomWqXgCbF7DN1YEp9wzgf4B7ZR-sxPyNPHIwZnz_UM_L13fWX7Ydm9_n9x-2bXWOk0rIB3hvROSvqtvYcOtu1PYLsRd8C12h6p4SwWnLrkFmn2ZXQFgUq3bpKG3lGXq--c4rfl_rxYfLZ4DhCwLjkQbSq033PpKro-YoeJ88J3TAnP0G6GzgbjnENNa7hPq7KvnywXfYT2n_k33wqcLkCt37Eu_87DW-vP62WfwBLvqbr</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Takeda, Teruyuki</creator><creator>Kishi, Masahiro</creator><creator>Takatsu, Noritaka</creator><creator>Takada, Yasumichi</creator><creator>Beppu, Tsuyoshi</creator><creator>Miyaoka, Masaki</creator><creator>Hisabe, Takashi</creator><creator>Ueki, Toshiharu</creator><creator>Arima, Hisatomi</creator><creator>Hirai, Fumihito</creator><creator>Yao, Kenshi</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202203</creationdate><title>Long‐term outcomes of endoscopic balloon dilation for intestinal strictures in patients with Crohn's disease during maintenance treatment with anti‐tumor necrosis factor alpha antibodies</title><author>Takeda, Teruyuki ; Kishi, Masahiro ; Takatsu, Noritaka ; Takada, Yasumichi ; Beppu, Tsuyoshi ; Miyaoka, Masaki ; Hisabe, Takashi ; Ueki, Toshiharu ; Arima, Hisatomi ; Hirai, Fumihito ; Yao, Kenshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3493-a17c26fd2111b1a6d657ea37275a19ec7f422d931dfe0df90829de2e495fa6dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Constriction, Pathologic - complications</topic><topic>Crohn Disease - complications</topic><topic>Crohn Disease - pathology</topic><topic>Crohn’s disease</topic><topic>Dilatation - adverse effects</topic><topic>dilation</topic><topic>endoscopy</topic><topic>Endoscopy, Gastrointestinal - adverse effects</topic><topic>Humans</topic><topic>Intestinal Obstruction - etiology</topic><topic>Retrospective Studies</topic><topic>stricture</topic><topic>TNF‐α inhibitor</topic><topic>Treatment Outcome</topic><topic>Tumor Necrosis Factor Inhibitors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takeda, Teruyuki</creatorcontrib><creatorcontrib>Kishi, Masahiro</creatorcontrib><creatorcontrib>Takatsu, Noritaka</creatorcontrib><creatorcontrib>Takada, Yasumichi</creatorcontrib><creatorcontrib>Beppu, Tsuyoshi</creatorcontrib><creatorcontrib>Miyaoka, Masaki</creatorcontrib><creatorcontrib>Hisabe, Takashi</creatorcontrib><creatorcontrib>Ueki, Toshiharu</creatorcontrib><creatorcontrib>Arima, Hisatomi</creatorcontrib><creatorcontrib>Hirai, Fumihito</creatorcontrib><creatorcontrib>Yao, Kenshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takeda, Teruyuki</au><au>Kishi, Masahiro</au><au>Takatsu, Noritaka</au><au>Takada, Yasumichi</au><au>Beppu, Tsuyoshi</au><au>Miyaoka, Masaki</au><au>Hisabe, Takashi</au><au>Ueki, Toshiharu</au><au>Arima, Hisatomi</au><au>Hirai, Fumihito</au><au>Yao, Kenshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term outcomes of endoscopic balloon dilation for intestinal strictures in patients with Crohn's disease during maintenance treatment with anti‐tumor necrosis factor alpha antibodies</atitle><jtitle>Digestive endoscopy</jtitle><addtitle>Dig Endosc</addtitle><date>2022-03</date><risdate>2022</risdate><volume>34</volume><issue>3</issue><spage>517</spage><epage>525</epage><pages>517-525</pages><issn>0915-5635</issn><eissn>1443-1661</eissn><abstract>Background and aims
Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn’s disease (CD) receiving anti‐tumor necrosis factor alpha antibodies (anti‐TNF) as maintenance therapy is unclear. We investigated the long‐term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti‐TNF.
Methods
We retrospectively analyzed data from patients with CD who received anti‐TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥6 months. The primary endpoint was the cumulative surgery‐free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety.
Results
Seventy‐two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3‐ and 5‐year cumulative surgery‐free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36–10.01; P = 0.011). Serious complications requiring surgery developed in three patients.
Conclusions
Endoscopic balloon dilation was an effective and safe short‐term treatment and a useful long‐term treatment for CD patients with intestinal strictures receiving anti‐TNF as maintenance therapy.</abstract><cop>Australia</cop><pmid>34185921</pmid><doi>10.1111/den.14073</doi><tpages>9</tpages></addata></record> |
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| ispartof | Digestive endoscopy, 2022-03, Vol.34 (3), p.517-525 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Constriction, Pathologic - complications Crohn Disease - complications Crohn Disease - pathology Crohn’s disease Dilatation - adverse effects dilation endoscopy Endoscopy, Gastrointestinal - adverse effects Humans Intestinal Obstruction - etiology Retrospective Studies stricture TNF‐α inhibitor Treatment Outcome Tumor Necrosis Factor Inhibitors |
| title | Long‐term outcomes of endoscopic balloon dilation for intestinal strictures in patients with Crohn's disease during maintenance treatment with anti‐tumor necrosis factor alpha antibodies |
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