Efficacy and safety of endoscopic treatment of ileal pouch strictures

Authors

  • Bo Shen MD,

    Corresponding author
    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
    • Department of Gastroenterology/Hepatology-Desk A31, the Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195
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  • Lei Lian MD,

    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
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  • Ravi P. Kiran MD,

    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
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  • Elaine Queener LPN,

    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
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  • Ian C. Lavery MD,

    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
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  • Victor W. Fazio MB, MS,

    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
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  • Feza H. Remzi MD

    1. Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio
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  • This study was partially supported by a BMRP grant of Eli and Edyth Broad Foundation and a CCFA grant.

Abstract

Background:

Endoscopic management of ileal pouch strictures has not been systemically studied. The aim was to evaluate endoscopic balloon therapy of pouch strictures in inflammatory bowel disease (IBD) patients with ileal pouches and to identify risk factors for pouch failure for those patients.

Methods:

Consecutive IBD patients with pouches from the Pouchitis Clinic who underwent nonfluoroscopy-guided outpatient endoscopic therapy were studied. The location, number, degree (range 0–3), and length of strictures and balloon size were documented. Efficacy and safety were evaluated with univariate and multivariate analyses.

Results:

A total of 150 patients with pouch strictures were studied. Stricture locations were at the pouch inlet (n = 96), outlet (n = 73), afferent limb (n = 33), and pouch body (n = 2). A cumulative of 646 strictures were endoscopically dilated, with a total of 406 pouchoscopies. The median stricture score was 1 (interquartile range [IQR] 1–2); the median stricture length was 1 (IQR 0.5–1.25) cm, and the median balloon size was 20 (IQR 18–20) mm. Of 406 therapeutic endoscopies performed, there were two perforations (0.46%) and four transfusion-required bleeding (0.98%). The 5-, 10-, and 25-year pouch retention rates were 97%, 90.6%, and 85.9%, respectively. In a median follow-up of 9.6 (IQR 6–17) years, 131 patients (87.3%) were able to retain their pouches. The number of strictures and underlying diagnosis were independent risk factors for pouch failure in the Cox regression model.

Conclusions:

Endoscopic treatment of pouch stricture appears to be efficacious and generally safe to perform in experienced hands. Underlying diagnosis of Crohn's disease of the pouch and surgery-related strictures and multiple strictures were the risk factors for pouch failure. (Inflamm Bowel Dis 2011)

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