Introduction

Crohn's disease (CD) is a chronic inflammatory condition of the digestive tract characterized by a cyclical course, the most frequent and feared complication is the formation of stenoses. The management of these stenoses is often multidisciplinary medico-surgical as well as endoscopic.
Endoscopy plays an essential role in the diagnosis, monitoring, and treatment of these stenoses, particularly through endoscopic dilations. The objective of our work is to study the role of endoscopic dilations during stenosing Crohn's disease in addition to medical treatment.

Aims & Methods

This is a single-center descriptive retrospective study carried out within our department over a period of 6 years: from January 2018 to January 2024, including all patients followed for stenosing Crohn's disease who underwent endoscopic dilation. We collected data related to age, history, location, phenotype, clinical symptoms, endoscopic data as well as evolution.

Results

We included 19 patients followed in our training for stenosing Crohn's disease who benefited from endoscopic dilation out of a total of 109 patients followed for Crohn's disease with a stenosing phenotype (17.4%). The average age was 45 years with extremes ranging from 20 to 71, with a male predominance and a M/F sex ratio: 2.8 (14 M and 5 F).
Three patients were smokers (15.8%), 6 patients underwent anterior ileocecal resection (31.6%) and a total colectomy ATCD in one patient (5.3%). The median time from diagnosis of Crohn's disease to formation of symptomatic stenosis was 9.3 years.
Clinically, abdominal pain was present in 8 patients (42.1%), Koenig syndrome in 7 patients (36.8%), diarrhea in 3 patients (21%), 4 patients (28.5%). had defecatory pain, evacuation constipation in 3 patients (15.8%) and late postprandial vomiting was present in 1 patient (5.3%).
The stenosis was at the last ileal loop in 5 cases (26.3%), 4 (21%) at the rectal level, 1 stenosis respectively at the colonic, anal, esophageal, pyloric and duodenal level (5.3% each) and 5 stenoses at the level of the anastomosis including 4 (21%) at the level of the ileocolic anastomosis and 1 at the level of the ileorectal anastomosis (5.3%).
The average length of the stenoses was 19.2 mm with extremes ranging from 5 to 40 mm. Dilations were carried out using hydrostatic dilation balloons whose caliber varied between 10 and 16.5 mm, 3 (15.8%) patients benefited from dilation to 16.5 mm, 7 (36.8%) at 12mm, 6 (31.6%) at 15mm, and 2 (10.5%) at 11mm.
11 patients benefited (57.9%) from a single dilation session, 7 patients benefited from 2 dilations (36.8%) and 1 patient (5.3%) had recourse to 5 dilations.
Primary success defined by the passage of the endoscope was possible in 15 patients (78.9%). Only one perforation type complication was noted, treated surgically.
The secondary success rate defined by the disappearance of symptoms was in 9 patients (47%). The average follow-up was 31.8 months and the clinical recurrence rate was 37.5% at 6 months. 4 patients (21%) benefited from additional surgery.

Conclusion

Endoscopic dilation is a minimally invasive treatment which constitutes an effective alternative to surgery in the management of stenoses during Crohn's disease; in our study more than half of our patients only had recourse to a single dilation session with a primary success of more than 78.9%, and a disappearance of symptoms at 6 months in almost half of the patients, thus making the use of surgery less frequent.