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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. Dr Gustavsson and colleagues had to evaluate 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. The researchers 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. The doctors noted that among current smokers, 31 out of 32 underwent another intervention compared to 18 out of 33 among never smokers.  | | Smoking doubles the risk of recurrent stricture formation | | Alimentary Pharmacology & Therapeutics |
After 5 years, cumulative probability of new intervention was 0.8 in smokers compared to 0.5 in never smokers; difference 0.3. The research team reported that in 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation. The team found that 7 out of 16 patients 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 doctors found that sex, age at diagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome. Dr Gustavsson's team concluded, "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."
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