Balloon Dilatation

The stenosis of the small intestine is one of the typical symptoms of CD. The standard treatment should be strictureplasty or resection of the affected part [34]. The less common clinical manifestation is large-intestine stricture, which is diagnosed when a colonoscope of a standard diameter (13-13.6 mm) cannot be inserted through the affected part of the intestine. The clinical manifestations of the stricture include flatulence, tenesmus (when the stricture is localised near the rectum), constipation, abdominal pain, ileus or subileus [34]. The exacerbation and severity of symptoms depend on the diameter of the narrowing. An intestinal diameter greater than 13 mm usually suffices for correct passage. When the diameter of the stricture falls below 9 mm, it leads to increased symptoms of obstruction [35]. This type of changes is observed usually in neoplastic tumours of the large intestine. When neoplastic etiology is excluded, the most frequent causes are the healing complications of the anastomosis, inflammatory bowel disease, the ischaemia as well as postradio-therapy changes. Segmental resection is the most common procedure in treating strictures. The alternative to the surgical procedure is dilation of the narrowed fragment with an endoscopic balloon. It should be performed under endoscopic visualisation as well as/or X-ray scopy. After direct visualisation of a stricture the wire guide of the balloon is passed through the narrowing. The balloon is then filled with iodine contrast medium under pressure of 1.5-3 atm. The visualisation of the stricture with the balloon in X-ray scopy allows accurate assessment of the effectiveness of the operation. The pressure in the balloon is maintained for about 2 min and can be repeated 2-3 times [35, 36].

Endoscopic dilatation is an effective method. The improvement in the clinical picture after 3 months was observed for 50-94% of patients depending on the centre and the patient's profile [37,38]. The effectiveness of the operation depends on the diameter of the balloon used, the applied pressure and the initial cause of the stenosis and the level of inflammatory process at the site of stenosis. More severe inflammatory changes in the affected intestine, which are typical for CD are not a contraindication for the procedure. Some authors recommend local steroid injections if severe inflammation is present [39]. Despite the coexistence of the inflammatory process, long-term results are encouraging for CD patients. In about two thirds of cases, patients in this group may avoid the necessity of surgical operation [37]. According to Sabate [37], the probability of surgery for stenosis following endoscope dilatation is 26% in the first year.

In the 5 years following endoscopic balloon dilatation, the probability grows to 46%. Couckuyt [40] achieved long-term clinical improvement in 34 of 55 patients who underwent endoscopic balloon dilatation (62%) in 33.6 months during follow-up, but also notes a high risk of perforation in this group. This complication was observed in six patients (11%). In four cases conservative treatment was sufficient while two patients underwent resection of the affected intestine. The rate of complications was not connected with the higher mortality. Results of other studies show a smaller rate of perforation (0-4.7%) [41].

The endoscopic treatment of large-intestine stenosis in patients with CD is a valuable alternative to classic surgical methods. These methods are characterised by a high effectiveness in reducing the subjective manifestations. Endoscopic methods decrease the frequency of surgical intervention and lower the risk of complications. Endoscope balloon dilatation is a method of choice for treatment of large-intestine stenosis in the course of Crohn's disease.

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Constipation Prescription

Constipation Prescription

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