Description

Balloon dilatation of strictures in Crohn’s disease

I was interested to read the article by Brian Saunders on Advances in therapeutic colonoscopy.1 It may be worth drawing to the attention of readers the work published in abstract form by Raedler A, et al; Gastroenterology 1997, 112 (4a 1067), who described a placebo controlled study of Azathioprine and Budesonide therapy following balloon dilatation of strictures. He showed a dramatically different stricture recurrence rate at eight months when Crohn’s disease strictures were treated with Azathioprine and Budesonide versus placebo.

In light of this information it is our practice to treat recurrent Crohn’s disease with anastomotic strictures that have been treated with balloon dilatation with immunosuppression with Azathioprine. It would probably be appropriate when in any future investigations of the affect of intralesional steroid injections for this to be compared with systemic immunosuppression or as an additional therapy to systemic immunosuppression.

References

1. Saunders B. Advances in therapeutic colonoscopy (Part 2: Endoscopic management of colonic strictures).CME journal Gastroenterology 1999; 2: 12-15.