Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn's disease.
Factors predicting outcome of the procedure are not well described.
Professor Tysk and colleagues from Sweden evaluated whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation.
The endpoint was requirement of a new intervention such as dilation or surgery with intestinal resection or strictureplasty.
|Among current smokers, 97% underwent another intervention|
|Alimentary Pharmacology & Therapeutics|
The research team performed a retrospective study of 83 patients with Crohn's disease who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009.
After index dilation, 55 out of 83 patients underwent a new intervention.
Among current smokers, 97% underwent another intervention compared to 55% among never smokers.
After 5 years, the team found that the cumulative probability of new intervention was 0.8 in smokers compared to 0.5 in never smokers.
In 16 patients, the research team found that therapy with azathioprine was initiated before or shortly after the index dilation.
The team noted that 7 out of 16 underwent a new intervention compared to 48 out of 67 of those without azathioprine.
After adjustment for other variables, the association was even weaker.
The researchers observed that sex, age at diagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome.
Professor Tysk's team concludes, "Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation."
"Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention."