The following is a summary of “Endoscopic Balloon Dilatation in Pediatric Crohn Disease: An IBD Porto Group Study,” published in the July 2023 issue of the Pediatric Gastroenterology and Nutrition by Ledder et al.

Endoscopic balloon dilatation (EBD) has demonstrated efficacy and safety in adult patients with structuring Crohn’s disease (CD); however, there is limited available data regarding its use in pediatric populations. Researchers objective was to evaluate the effectiveness and safety of endoscopic balloon dilation (EBD) in treating stricturing pediatric Crohn’s disease (CD). The international collaboration comprised 11 medical centers in Europe, Canada, and Israel. The collected data encompassed patient demographics, structural characteristics, clinical outcomes, procedural complications, and surgical requirements. The primary outcome measure assessed the absence of surgical intervention within 12 months, while the secondary outcome measures included the clinical response to treatment and any adverse events experienced.

About 88 dilatations were conducted across 64 dilatation series involving 53 patients. The average age at Crohn’s disease (CD) diagnosis was 11.1 years, with a standard deviation of 4.0 years. The length of the criticisms was 4 cm, with an interquartile range (IQR) of 2.8 to 5 cm. The thickness of the bowel wall was 7 mm, with an IQR of 5.3 to 8 mm. Twelve out of 64 (19%) individuals underwent a surgical procedure within the year following the dilatation series, with a median time of 89 days (interquartile range 24–120; range 0–264) after endoscopic balloon dilatation (EBD). About 7 out of 64 individuals (11%) experienced subsequent unplanned episodes of EBD (Episodic Bowel Dysfunction) within one year. Among these individuals, two eventually required surgical resection. 

Around 2 out of 88 (2%) cases of perforation were documented, one of which required surgical intervention, while 5 patients experienced minor adverse events that were managed non-surgically. There was a notable enhancement in all medical assessments after EBD, with a rise in remission as defined by the weighted pediatric CD activity index from 13% at the beginning to 44%, 46%, and 61% at weeks 2, 8, and 24, respectively. At these respective time points, obstructive symptoms were absent in 55%, 53%, and 64% of patients. In this extensive study on pediatric stricturing Crohn’s disease, investigators have shown that endoscopic balloon dilation (EBD) is a successful intervention for alleviating symptoms and circumventing the need for surgical procedures. The incidence of adverse events was low and in line with the data observed in adult patients.

Source: journals.lww.com/jpgn/Abstract/2023/07000/Endoscopic_Balloon_Dilatation_in_Pediatric_Crohn.10.aspx