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Gastrointest Endosc. 2010 Dec;72(6):1201-8. doi: 10.1016/j.gie.2010.08.003. Epub 2010 Oct 16.

Intralesional steroid injection after endoscopic balloon dilation in pediatric Crohn's disease with stricture: a prospective, randomized, double-blind, controlled trial.

Author information

1
Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.

Abstract

BACKGROUND:

Endoscopic balloon dilation (EBD) is an attractive conservative therapy for Crohn's disease (CD) with stricture; however, its long-term efficacy has been questioned because many patients require more dilations or postdilation surgery. Most reports are retrospective, and no pediatric data are available.

OBJECTIVE:

To assess the effectiveness of corticosteroid intralesional injection after EBD in preventing stricture recurrence.

DESIGN:

Single-center prospective, randomized, double-blind, controlled trial.

SETTING:

Tertiary-referral university hospital.

PATIENTS:

Between November 2005 and January 2009, 29 pediatric patients with stricturing CD were enrolled.

INTERVENTIONS:

Enrolled patients were randomized to receive intrastricture injection of corticosteroid (CS) (n = 15) or placebo (n = 14) after EBD. Patients were followed clinically via small intestine contrast US and intestinal magnetic resonance imaging at 1, 3, 6, and 12 months; all underwent colonoscopy 12 months after dilation.

MAIN OUTCOME MEASUREMENTS:

Time free of repeat dilation and time free of surgery in the 2 groups.

RESULTS:

One of the 15 patients receiving CS required redilation, whereas the latter was needed in 5 of the 14 placebo patients; surgery was needed in 4 of the placebo patients, but in none of those receiving CS. The 2 groups statistically differed in the time free of redilation (P = .04) as well as for time free of surgery after EBD (P = .02), which were worse in the placebo group compared with the CS group. There were no significant differences in baseline demographics between the 2 groups.

LIMITATIONS:

Sample size, participation bias, and short-term follow-up.

CONCLUSION:

In pediatric CD with stricture, intralesional CS injection after EBD is an effective strategy for reducing the need both for redilation and surgery.

PMID:
20951986
DOI:
10.1016/j.gie.2010.08.003
[Indexed for MEDLINE]

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