Original article—alimentary tractA Pilot Study of Intrastricture Steroid Versus Placebo Injection After Balloon Dilatation of Crohn’s Strictures
Section snippets
Methods
Patients aged 18 years or older presenting to St. Mark’s Hospital who had symptomatic Crohn’s strictures, less than 5 cm in length as assessed by barium studies, and thought to be suitable for colonoscopic dilatation (ie, endoscopically accessible), were invited to participate in this study. Patients also had to have failed medical therapy with steroids and aminosalicylates. All patients gave written informed consent and the study was approved by the local research ethics committee. Recruitment
Results
Thirteen patients were recruited, 7 were randomized to the steroid group and 6 were randomized to the placebo group. All patients in the steroid group had follow-up evaluation until week 52; 4 of 6 patients in the placebo group had follow-up evaluation until week 52. Data for the 2 patients who did not complete the follow-up evaluation were available until days 113 and 160 postdilatation, and they were censored at these points. Further follow-up data for these patients to week 52 subsequently
Discussion
In this pilot study, quadrantic intrastricture injection of triamcinolone 40 mg after balloon dilatation of Crohn’s ileocolonic anastomotic strictures did not improve time to redilatation or surgery. In fact, there was an unexpected trend for the need for earlier redilatation with the use of triamcinolone in the intention-to-treat analysis, which was statistically significant in the per-protocol analysis.
This patient group was very similar in terms of age, body mass index, Crohn’s duration, and
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2020, Clinical Gastroenterology and HepatologyCitation Excerpt :With regard to technical aspects of EBD, a majority of the studies used maximum balloon diameter of 18–20 mm90,91 with a 2- to 3-minute duration of maximal dilation.91 Current data do not support intralesional injection of corticosteroids.90–92 Although few small case series report benefit following intralesional injection of infliximab, in the absence of larger randomized controlled trials this remains a somewhat restricted therapeutic strategy.93,94