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PubMed2004

Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials.

BACKGROUND: For the scientific evaluation of the endoscopic and open mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials (RCT) are necessary. The Lichtenstein repair is one of the most common open mesh techniques and therefore of special interest. METHODS: After an extensive search of the literature and a quality assessment, a total of 34 RCT comparing endoscopic procedures both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP)--with various open mesh repairs were deemed to be suitable for a formal meta-analysis of the relevant parameters. These studies included data for 7,223 patients. Trials that used the Lichtenstein repair for the control group (23 of 34 trials) were analyzed-separately. RESULTS: Significant advantages for the endoscopic procedures compared with the Lichtenstein repair include a lower incidence of wound infection (Peto odds ratio, 0.39; 95% confidence interval, 0.26, 0.61), a reduction in hematoma formation (0.69 [0.54, 0.90]) and nerve injury (0.46 [0.35, 0.61]), an earlier return to normal activities or work (-1.35[-1.72, -0.97]), and fewer incidences of chronic pain syndrome (0.56[0.44, 0.70]). No difference was found in total morbidity or in the incidence of intestinal lesions, urinary bladder lesions, major vascular lesions, urinary retention and testicular problems. Significant advantages for the Lichtenstein repair include in a shorter operating time (5.45[1.18, 9.73]), a lower incidence of seroma formation (1.42[1.13, 1.79]), and fewer hernia recurrences (2.00[1.46, 2.74]). Similar results are seen when endoscopic procedures are compared with other open mesh repairs. However, in this comparison, total morbidity was lower with the endoscopic operations (0.73[0.61, 0.89]). The incidence of seroma formation, chronic pain syndromes, and hernia recurrence was not significantly different. CONCLUSION: Endoscopic repairs do have advantages interms of local complications and pain-associated parameters. For more detailed evaluation further well-structured trials with improved standardization of hernia type, operative technique, and surgeons' experience are necessary.

Digestive System Surgical Procedures↗
PubMed2006

Endoscopic band ligation therapy for upper gastrointestinal bleeding related to Mallory-Weiss syndrome.

BACKGROUND: No consensus exists as to the best endoscopic treatment for Mallory-Weiss syndrome. Endoscopic band ligation is a readily available and easily learned technique. This prospective study evaluated the efficacy and safety of endoscopic band ligation therapy for Mallory-Weiss syndrome. METHODS: From August 1998 to June 2005, a clinical trial assessed 37 patients with a diagnosis of Mallory-Weiss syndrome who had active bleeding, exposed vessels, or both. Their lesions were treated using endoscopic band ligation. RESULTS: Endoscopic band ligation was successful in 36 of 37 cases, with a follow-up period ranging from 1 to 24 months. The remaining patient had severe liver failure and disseminated intravascular coagulation. The patient bled again at 12 h and subsequently died. Except for this case, no recurrent bleeding, perforation, or other complications occurred. CONCLUSIONS: The study results suggest that endoscopic band ligation is an effective, safe, and easily learned procedure for treating upper gastrointestinal bleeding related to Mallory-Weiss syndrome.

Adult↗
PubMed2006

The influence of different training schedules on the learning of psychomotor skills for endoscopic surgery.

BACKGROUND: Psychomotor skills for endoscopic surgery can be trained with virtual reality simulators. Distributed training is more effective than massed training, but it is unclear whether distributed training over several days is more effective than distributed training within 1 day. This study aimed to determine which of these two options is the most effective for training endoscopic psychomotor skills. METHODS: Students with no endoscopic experience were randomly assigned either to distributed training on 3 consecutive days (group A, n = 10) or distributed training within 1 day (group B, n = 10). For this study the SIMENDO virtual reality simulator for endoscopic skills was used. The training involved 12 repetitions of three different exercises (drop balls, needle manipulation, 30 degree endoscope) in differently distributed training schedules. All the participants performed a posttraining test (posttest) for the trained tasks 7 days after the training. The parameters measured were time, nontarget environment collisions, and instrument path length. RESULTS: There were no significant differences between the groups in the first training session for all the parameters. In the posttest, group A (training over several days) performed 18.7% faster than group B (training on 1 day) (p = 0.013). The collision and path length scores for group A did not differ significantly from the scores for group B. CONCLUSION: The distributed group trained over several days was faster, with the same number of errors and the same instrument path length used. Psychomotor skill training for endoscopic surgery distributed over several days is superior to training on 1 day.

Adult↗
PubMed2005

Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt.

Endoscopic gallbladder stenting is useful palliative therapy for acute cholecystitis in high-risk patients. Although the success rate of endoscopic gallbladder stenting is 79%-100%, an alternative method has not been reported. We succeeded in employing a method for percutaneous gallbladder stenting (PTGS) and herein describe this new method. A patient with acute acalculous cholecystitis related to ischemic atherosclerotic vascular disease, cholangitis due to Lemmel syndrome, and severe congestive heart failure underwent PTGS through the cystic duct from the gallbladder to the duodenal papilla, because an endoscopic method failed in the treatment of Lemmel syndrome. Because we were unable to place endoscopic transpapillary gallbladder drainage, percutaneous transhepatic gallbladder drainage (PTGBD) was performed and both the cholecystitis and cholangitis ceased. PTGS was performed as an alternative to endoscopic gallbladder stenting. Access to the cystic duct and gallbladder was obtained by the PTGBD route, using a guidewire (0.035-inch diameter) and seeking catheter (6.5 Fr) under fluoroscopic control. A 7-Fr 12-cm double-pigtail biliary polyethylene stent was placed. The patient remained asymptomatic for 3 months after the PTGS until he died, of an acute recurrent myocardial infarction. This new PTGS placement is an alternative treatment for symptomatic gallbladder disease in patients with increased operative risk when the endoscopic method is unsuccessful.

Acute Disease↗
PubMed2003

Neuro-endoscopic surgery--experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India.

BACKGROUND: Neuro-endoscopic surgery is finding increasing application for various clinical conditions. We present our experience of 100 cases of diverse intracranial lesions, including infections, managed by neuro-endoscopy in a busy neurosurgical department in the developing world. MATERIAL AND METHODS: One hundred patients treated from March 1996 to February 2002 formed the study group. Management of hydrocephalous by Endoscopic third ventriculostomy (ETV) was the aim in 75 patients with or without diagnostic biopsy. Excision or resection was attempted in 25 patients with juxtaventricular or intraventricular lesions. Endoscopic procedures included total tumour resection, partial resection, biopsy, stent placement, Monroplasty, septostomy and third ventriculostomy. Outcomes of endoscopic surgery were evaluated with respect to clinical and/or radiological improvement, complications and need for additional therapy. FINDINGS: Endoscopy was the only surgical treatment in 59 patients. Intermittent lumbar drainage for cerebrospinal fluid leak, shunt, microsurgery and/or repeat endoscopic surgery were additional treatments needed in 39 patients, who subsequently had increased hospital stay, postoperative morbidity and a higher cost of treatment. Peroperative bleeding due to distorted anatomy and obscured vision in 2 patients with post-infective loculated hydrocephalus (LH) resulted in two fatalities (2%) in the early post-operative period. INTERPRETATION: Neuro-endoscopic surgery cuts down operative time and hospital stay, reduces cost and results in a faster turnover of the patients. It is a versatile and useful tool for a busy neurosurgical department.

Adolescent↗
PubMed2004

Endoscopic polypectomy: techniques, complications and follow-up.

Colorectal cancer is one of the most common cancers in developed countries. Increasing numbers of early stage colorectal cancers and precancerous adenomatous lesions, polypoidal type lesions, and flat and depressed type lesions can be visualised and treated endoscopically thanks to endoscopic ultrasonography, high magnification chromoendoscopy and other technical advances. Polypectomy is generally considered for protuberant lesions, with both sessile and pedunculate morphology, and endoscopic mucosal resection (EMR) is indicated for superficial, flat or depressed types of lesions. Endoscopic therapy for colonic adenoma with dysplasia and early colorectal cancer is more advantageous than the conventional operative treatment, in that it is a relatively non-invasive and less costly method. However, endoscopic therapy is completely ineffective in lesions with lymph node or distant metastasis. Therefore, it is becoming more and more important to understand the correct indications and limitations of endoscopic polypectomy/mucosectomy as well as complication rates and the correct follow-up schedule.

Aftercare↗
PubMed1989

Endoscopic management of bile duct stones.

Endoscopic sphincterotomy is the procedure of choice for choledocholithiasis in patients who have had a cholecystectomy. The bile duct is cleared of stones in about 80 to 90 percent of patients. Available data, largely retrospective, suggest that surgery and endoscopic sphincterotomy are about equal with respect to removal of stones, morbidity, and mortality. Certain technical problems are discussed, including inability to insert the papillotome, the large stone, and problems relating to anatomy such as peripapillary diverticulum and prior gastrectomy. The treatment of patients with bile duct stones who have not had a cholecystectomy, with and without cholelithiasis, is controversial. Endoscopic sphincterotomy without subsequent cholecystectomy is adequate treatment for the majority of patients who are unfit for surgery, even if there are stones in the gallbladder, provided they are asymptomatic after endoscopic removal of stones from the bile ducts. Endoscopic sphincterotomy has been performed in the treatment of gallstone-induced pancreatitis, acute obstructive cholangitis, and sump syndrome. The complication rate for endoscopic sphincterotomy ranges from 6.5 to 8.7 percent, with a mortality rate of 0 to 1.3 percent. The most common serious complications are perforation, hemorrhage, acute pancreatitis, and sepsis.

Acute Disease↗
PubMed1994

Postoperative bronchopleural fistula: endoscopic closure in 12 patients.

Twelve consecutive patients with postresectional bronchopleural fistula were treated with endoscopic application of tissue glue adhesive (methyl-2-cyanoacrylate). Eight patients had associated empyema. Endoscopic gluing was successfully accomplished in 10 cases (success rate of 83%). The two failures both had fistulas of 0.5 cm or larger. Bronchopleural fistulas developed in 8 patients early after the intervention (< 15 days): of the 4 patients without associated empyema, 3 had their fistula definitely closed after endoscopic treatment. Similarly, 3 of the 4 patients with early bronchopleural fistulas and empyema were cured after endoscopic closure of the fistula and appropriate management of the empyema. Four bronchopleural fistulas occurred late after the operation (> 15 days) and all had associated empyema. Successful endoscopic closure of the fistula was accomplished in all. Resolution of the empyema occurred in 1. We conclude that endoscopic application of tissue adhesive may be a valid therapeutic measure in selected patients with postresectional bronchopleural fistula. In late bronchopleural fistula with empyema, the closure of the fistula can be achieved, but empyema may persist and require additional surgical procedures.

Aged↗
PubMed1986

Endoscopic ultrasonography of non-Hodgkin lymphoma of the stomach.

Endoscopic ultrasonography was performed in 8 patients with non-Hodgkin lymphoma of the stomach. Findings consisted of intramural infiltration or mucosal alteration together with perigastric lymph nodes, or both. Lymph node involvement was suggested by the presence of inhomogeneous hypoechoic echopatterns with clearly demarcated borders. Endoscopic ultrasonography was more accurate than computed tomography scan in the detection of transmural extent of malignancy and adjacent lymph node involvement. Because of the limited penetration depth of endoscopic ultrasonography, approximately 10 cm, more distant lymph nodes might be more clearly detected with computed tomography scan. Endoscopic ultrasonography was also more accurate than endoscopy and barium meal in the assessment of gastric wall infiltration. The resectability of gastric non-Hodgkin lymphoma was reliably detected by endoscopic ultrasonography before surgery. Endoscopic ultrasonography appears to be a sensitive diagnostic modality for detection, staging, and follow-up in gastric non-Hodgkin lymphoma. Technical improvements may further enhance the diagnostic value of this new procedure.

Adult↗
PubMed1990

Detection of duodenal gastrinomas by operative endoscopic transillumination. A prospective study.

The ability of operative endoscopic transillumination of the bowel wall to detect duodenal gastrinoma was evaluated prospectively in 26 patients with the Zollinger-Ellison syndrome. The results were assessed by exploratory laparotomy and compared with the results of other localization techniques. Twelve duodenal gastrinomas were resected from 10 patients. Operative endoscopic transillumination detected 10 of the 12 gastrinomas, a sensitivity of 83%, which was significantly greater (P less than 0.05) than that for either preoperative imaging (25%) or intraoperative ultrasonography and palpation (42%). The sensitivity of operative endoscopic transillumination was a result of the ability to detect focal areas that did not transilluminate on the serosal side of the duodenum, and not the mucosal appearances seen through the endoscope, which were not helpful. Operative endoscopic transillumination detected gastrinomas less than 1 cm in diameter throughout the duodenum. Of the patients in this study, 39% had duodenal gastrinomas, a greater frequency than previously reported. These results indicate that operative endoscopic transillumination is the most sensitive technique yet described for detecting duodenal gastrinomas and should be performed routinely in all patients with the Zollinger-Ellison syndrome who undergo exploratory laparotomy for cure.

Duodenal Neoplasms↗
PubMed1993

An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett's esophagus.

BACKGROUND: Surveying vs. performing resection in patients with high-grade dysplasia in Barrett's esophagus is debated because of concern about the accuracy of endoscopic biopsy diagnosis. The aim of this study was to investigate the accuracy of an endoscopic biopsy protocol in patients with neoplastic abnormalities in Barrett's epithelium without obvious esophageal cancer. METHODS: Preoperative and postoperative diagnoses in 28 patients who underwent surgery for high-grade dysplasia or early adenocarcinoma in Barrett's esophagus and compared them with 22 other patients with high-grade dysplasia who were maintained under prospective endoscopic surveillance. All 50 patients lacked gross lesions to suggest esophageal cancer. The endoscopic protocol involved rigorous, systematic acquisition of multiple, large biopsy samples. RESULTS: Overall, 64% of patients had minimal but distinct endoscopic abnormalities that were targeted for biopsies. High-grade dysplasia alone (7 patients) was differentiated from early adenocarcinoma (19 patients). Two patients with preoperative diagnoses of intramucosal adenocarcinoma had high-grade dysplasia in their resection specimens. CONCLUSIONS: This endoscopic protocol accurately detects and differentiates high-grade dysplasia from early adenocarcinoma in Barrett's esophagus. Patients with high-grade dysplasia alone in Barrett's esophagus detected by such a protocol do not necessarily require surgical resection to rule out an undiagnosed adenocarcinoma; electing for surgery should be based on other clinical considerations.

Adenocarcinoma↗
PubMed1993

Manometry of esophageal varices: comparison of an endoscopic balloon technique with needle puncture.

BACKGROUND: A noninvasive technique of pressure measurement in esophageal varices using an endoscopic balloon has been shown to be reliable in vitro. In the present study, this method was tested in vivo. METHODS: Thirty-seven pressure measurements in esophageal varices were performed in 34 patients by two independent operators (A and B) using an endoscopic balloon and compared with measurements performed by needle puncture by a third operator (C). RESULTS: Three measurements performed with the endoscopic balloon were rejected because they were noninterpretable. Measurements performed by A and B correlated well (correlation coefficient, 0.90); interobserver variability (r) was 0.88. Of 37 punctures performed for pressure measurements, 4 resulted in bleeding and 8 measurements were rejected as uninterpretable. Regression analysis showed a good correlation between the needle puncture and balloon techniques for pressure measurements performed by both operators (y = 5.3 + 1.0x, r = 0.8; y = 6.2 + 0.9x, r = 0.8), and analysis of variability showed a measurement bias of -5.3 +/- 4.1 and -4.1 +/- 3.5 cm H2O. No significant difference in variceal size measured with the endoscopic balloon or endoscopic forceps was found. CONCLUSIONS: The endoscopic balloon allows measurement of pressure in esophageal varices without hazard to the patient; in addition, it may be used to assess the varix size.

Adult↗
PubMed2006

Cancer risk in endoscopically unresectable colon polyps.

BACKGROUND: The purpose of the current study was to define the rate of underlying malignancy in endoscopically unresectable polyps. METHODS: An institutional review board-approved review identified all patients undergoing colectomy for radiologically identified or endoscopically unresectable polyps between 1997 and 2006. Patients were included if the endoscopic impression and biopsy findings suggested an adenomatous polyp without invasive cancer. Patient information was abstracted. RESULTS: Eighty procedures in 79 patients were identified. Median patient age was 66 (range 38 to 85) years, and patients were predominately male (98%) and Caucasian (73%). The median endoscopic size of polyps was 3.0 cm (range 0.8 to 10 cm). Polyps were most frequently proximal to the splenic flexure (72%). Biopsy histology included 36 (51%) tubulovillous and villous adenomas. Invasive cancer was identified in 13 of 80 (16%) subsequent surgical specimens, but only 3 of 71 (4%) were lymph node-positive. Surgical morbidity was 37% and in-hospital mortality 3%. Size of polyp (P = .81) and histologic type (P = .34) were not significantly associated with invasive cancer. Compared with polyps proximal to the splenic flexure, polyps located distally were more likely to harbor malignancy (rate; P < .02), by both univariate and multivariate analysis (odds ratio [OR] 1.38 [95% confidence interval 1.07 to 1.8]). CONCLUSION: The cancer risk in polyps deemed inappropriate for endoscopic resection was lower than previously reported. Neither polyp size nor histologic type appeared to be significantly associated with invasive cancer. Location of an endoscopically unresectable polyp distal to the splenic flexure confers an increased risk for occult malignancy.

Adult↗
PubMed2006

Intramedullary fracture reduction of long bone under visual control: experimental results of an endoscopic technique.

In controlling the closed reduction of a shaft fracture of long bone during an operation, intraoperative radiography is essential. The amount of imaging needed depends on the patient, the fracture, and the surgeon. This article documents our first experimental results of closed fracture reduction performed under direct visual control with the endoscopic technique of intramedullary bone endoscopy (IBE), which eliminates the need for fluoroscopy. On 3 human tibial cadaveric bones, an artificial shaft fracture was set. The lower leg was fixed on a brace, and the endoscope was inserted at the standard entry point for intramedullary nailing. The endoscope was gently pushed distally to prepare the medullary canal under visual control with the use of endoscopic instruments. At the level of fracture, surgeons achieved a closed reduction by "looking around" for the distal part of the fracture by using the stiff endoscope similarly to a "joystick." Thus, the proximal fragment was automatically guided into the correct position, and the fracture was reduced. The endoscopic tool was pushed down the medullary canal into the distal fragment in the way that a guidewire would be placed. Through this technique, it has been possible in all patients to reduce fractures under visual control. Fluoroscopy can be eliminated in these cases.

Cadaver↗
PubMed2004

Endoscopic localization and assessment of coronary arteries by 13 MHz epicardial ultrasound.

BACKGROUND: In totally endoscopic coronary artery bypass grafting the target coronary artery is difficult to locate and assess. We explored the capacity of a high-frequency epicardial ultrasound mini-transducer (Aloka, Tokyo, Japan) to endoscopically locate and assess the left anterior descending (LAD), third obtuse marginal (OM3), and right posterior descending (RDP) coronary arteries. METHODS: In eight pigs, the LAD, OM3, and RDP were endoscopically exposed. The mini-transducer was manipulated by the "da Vinci" telemanipulation system (Intuitive Surgical, Inc, Mountain View, CA) over the unstabilized and stabilized epicardium to identify the target artery, obtain a scout scan, and both transverse and longitudinal images. RESULTS: In both unstabilized and stabilized conditions, the LAD and RDP were identified within a median of 29 seconds. In stabilized conditions, assessment was complete in 112 seconds (92 to 205) (median with range) for the LAD and 140 seconds (54 to 197) for the RDP. Stabilization of the OM3 was required for identification (16 [5 to 60]) and assessment (111 [82 to 225]). Overall identification was correct in 23 of 24 arteries. The OM branches and RDP became fully exposed endoscopically with stroke volume (SV) and mean arterial pressure (MAP) remaining at 67% +/- 11% (mean +/- standard error of the mean) and 70% +/- 5% of baseline values, respectively. Scanning itself did not augment the decrease in SV and MAP significantly. CONCLUSIONS: After proper endoscopic exposure and stabilization, robot-assisted epicardial ultrasound scanning enabled endoscopic identification and assessment of major coronary arteries within a median of 169 seconds per artery. Exposure, stabilization, and scanning were accompanied by an acceptable drop in stroke volume and mean arterial pressure.

Animals↗
PubMed2006

Endoscopic resection of forehead osteomas.

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow. Sometimes, a patient seeking a solution for rejuvenation of the upper third of the face may present other problems such as a forehead lesion. The authors describe their clinical experience in surgical endoscopic excision of forehead osteomas. PATIENTS AND METHODS: In nine patients with a forehead osteoma, seeking for a solution in rejuvenating the upper third of the face, we performed a combination of endoscopic brow lift and endoscopic excision of the forehead osteoma. We also performed an endoscopic excision of a forehead osteoma in two patients that did not request any additional aesthetic face procedure. RESULTS: No complication and no recurrence have been reported. The aesthetic result satisfied the patients. CONCLUSIONS: Endoscopic resection of a forehead osteoma offers sufficient, effective and safe access for dissection and suspension of the tissues released. It offers a superbly hidden scar and is well appreciated by the patients.

Adult↗
PubMedDate not supplied

Initial experience using an endoscopic simulator to train surgical residents in flexible endoscopy in a community medical center residency program.

INTRODUCTION: The importance of training surgical residents in GI endoscopy has been recognized for years. Despite advice from SAGES and the RRC, few programs have managed to incorporate effective flexible endoscopy training into their curriculum, making it difficult for their graduates to be credentialed in GI endoscopy. Prior to October 2001, our residents obtained their entire clinical experience in the endoscopy unit with staff surgical endoscopists. Attendance was inconsistent because of their many other responsibilities, and residents often used much of their clinical endoscopic exposure gaining basic familiarity with the equipment, precluding the development of therapeutic facility. Since October 2001, we have used the Simbionix endoscopic simulator to supplement resident training in GI endoscopy. With the advent of virtual-reality simulators, and studies validating their effectiveness in teaching fundamental technical skills, we report our initial success in implementing a formal GI endoscopy curriculum using a virtual reality endoscopic simulator to provide basic experience before the clinical endoscopic experience begins. METHODS: Residents are given monthly assignments of simulated cases on the GI Mentor simulator. Junior residents complete the diagnostic case modules; senior residents complete the therapeutic modules. Data were accumulated over the course of two years with a total of five PGY-I and eight senior surgical residents completing assigned cases on the simulator. Objective criteria were measured from their performance on the simulator to determine the efficiency of the examination for each case completed. RESULTS: Preliminary data collected over the course of two years indicates that residents improve the efficiency of their endoscopic examinations over time as measured by objective criteria. Junior surgery residents attained an aggregate average of 59% efficiency in their examinations whereas senior surgical residents who had previous experience with the simulator, attained an aggregate efficiency of 80%. CONCLUSIONS: A formal flexible endoscopy curriculum enhances surgical resident training and positively impacts careers in general and gastrointestinal surgery. Endoscopic simulators allow surgical residents to master the technical aspects of GI endoscopy quickly, thereby permitting them more benefit from their clinical exposure in the endoscopy unit. We anticipate that our formal curriculum in GI endoscopy training will prepare our graduates well for careers that include flexible endoscopy as a component of their clinical practices, and position them to be credentialled in GI endoscopy upon graduation.

Colonoscopy↗
PubMed2003

Long-term outcome of endoscopic pneumatic dilatation in Crohn's disease.

BACKGROUND: To avoid multiple surgeries in stenosing Crohn's disease, pneumatic endoscopic dilatation has been introduced. The present study evaluated the long-term clinical outcome in Crohn's disease patients after endoscopic dilatation for ileal or neoileal strictures. PATIENTS AND METHODS: All Crohn's disease patients who underwent pneumatic dilatation of ileal or ileo-colonic strictures between January 1988 and December 2001 were invited to return for a clinical check-up in June 2002. Clinical, endoscopic and radiological reports were reviewed. Symptomatic relief from sub-occlusive symptoms without requiring surgery was considered as a positive outcome, whereas the requirement of surgery was regarded as an unfavourable outcome. Possible predictors of favourable outcome were analysed. RESULTS: Endoscopic dilatation was technically successful in 34/43 (79%) Crohn's disease patients, with a mean number of dilatations per patient of 3 +/- 3.13. During a mean follow-up of 63.7 +/- 44.6 months, a positive long-term outcome was observed in 18 (52.9%) patients, whereas surgery was necessary in the remaining 16 cases. The risk of surgery was distinctly higher within 2 years post-dilatation than in the next 2 years (26.4% versus 8.3%, respectively; P = 0.078). No clear clinical, endoscopic or radiological predictive factors for a successful outcome were identified. CONCLUSIONS: Endoscopic pneumatic dilatation is an effective and safe procedure to be applied to patients with stenosing Crohn's disease, offering a very long-term benefit in a sub-group of patients.

Adolescent↗