Usefulness of Fluoroscopy for Endoscopic Balloon Dilation of Crohn’s Disease-Related Strictures

Background: Fluoroscopy is often used for endoscopic balloon dilation (EBD) of Crohn’s disease (CD)-related strictures. However, its benefit remains unclear. Aims: To compare EBD with (EBDF) and without (EBDNF) fluoroscopic guidance in CD patients with strictures. Methods: Single-center, nested, case–control retrospective study of EBD for CD-related strictures. Technical and clinical success and safety outcomes were compared between EBDF and EBDNF. Results: A total of 122 strictures in 114 CD patients who underwent EBD from 2010 to 2018 at a single institution were reviewed (44 patients EBDF vs. 70 EBDNF). Esophagogastroduodenoscopy was the approach in 8 strictures, colonoscopy in 86, and deep enteroscopy in 28. There were no significant differences in the rates of technical and clinical success, need for repeat dilation and surgery between the two groups, although the mean maximal endoscopic balloon diameter was larger in the EBDNF group (17.1 ± 1.9 vs. 14.1 ± 2.5; p < 0.001). There was one perforation in EBDF and no serious complications in EBDNF. In multivariate analysis, balloon size < 15 mm (odds ratio [OR] 6.388; 95% CI 1.96–20.79; p = 0.002) and multiple strictures (OR 3.897; 95% CI 1.09–14.01; p = 0.037) were associated with repeat EBD, and age < 50 years (OR 7.178; 95% CI 1.38–37.44; p = 0.019) and small bowel (vs. colon) location (OR 7.525; 95% CI 1.51–37.47; p = 0.014) were associated with the need for surgery after EBD. Conclusions: EBD for CD-related strictures can be performed safely and effectively without fluoroscopic guidance. Balloon size, patient age, stricture location, and multiplicity are associated with clinical success and avoidance of surgery.