Introduction/Background Intestinal strictures are a complication of Crohn’s disease despite optimal medical management. Endoscopic balloon dilatation is frequently used for management of simple strictures in adults in comparison to the paediatric population. Therapeutic endoscopy is rarely performed in paediatric gastroenterology centres in the UK. Strictures in the duodenum, jejunum, ileal and colonic area are accessible by endoscopy and enteroscopy. Endoscopic balloon dilatation is a less invasive treatment option for management of short strictures and can defer surgical intervention.

Aim We aimed to evaluate the outcome of paediatric patients undergoing stricture dilatation over a 10-year period.

Subjects and Methods We retrospectively reviewed all paediatric patients with Crohn’s disease who underwent endoscopic balloon dilatation at a tertiary paediatric gastroenterology centre in the last 10 years (2010 to 2020). Strictures were identified using magnetic resonance enterography (MRE) and also during endoscopy. Patients were booked for endoscopic balloon dilatation if they were symptomatic and had pre-stenotic dilatation on MRE or inability to pass colonoscopy into stenosed lumen at previous endoscopy. Both paediatric colonoscopy and single balloon enteroscopy was used for endoscopic balloon dilatation which was done under fluoroscopy guidance. Clinical and endoscopic data were collected from electronic patient records.

Results During the 10-year period 20 patients with Crohn’s disease underwent endoscopic balloon dilatation. The mean age of diagnosis of Crohn’s disease was 12.45 years (5- 16.4 yrs) and the mean age at the time of the occurrence of first stricture was 14.2 years (10.9- 17.9 yrs). 65% patients were on biologics and 85% were on an immunomodulator (azathioprine, methotrexate or mycophenolate mofetil). Multiple strictures were noted in 25% of patients. Location of strictures included ileal, ileocaecal, sigmoid and caecal.

A total of 32 dilatations were performed in the 20 patients and 8 patients underwent multiple endoscopic balloon dilatations (7 patients underwent 2 dilatations and 1 patient had 6 dilatations). 85% of patients were symptomatic (abdominal pain, vomiting) from the stricture and after endoscopic balloon dilatation in 70.5% the symptoms had improved.

There were 2 procedure related complications 0.06% (1 perforation requiring surgery and 1 perforation was managed conservatively). Mean follow-up since the first stricture dilatation was 2.67 years (0.1- 6.11 yrs). During the follow-up of these 20 patients; 4 underwent stricture related surgery and 80% have not undergone any surgical intervention.

Summary and Conclusion Our experience has shown that endoscopic balloon dilatation is a relatively safe procedure for the treatment of luminal strictures. Endoscopic balloon dilatation results in symptomatic relief and delays surgical intervention in Crohn’s patients with luminal strictures.