Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: A retrospective case series

Background and Study Aims: Endoscopic balloon dilation of Crohn's strictures is widely practised, but may not result in long-term symptomatic benefit, leading to the need for repeat dilation or surgery. It is hypothesized that long-acting steroid injection into strictures after dilation may decrease the need for further stricture dilation and improve the outcome in symptomatic patients. Patients and Methods: Patients with Crohn's disease who have had balloon dilation and triamcinolone injection performed for symptomatic anastomotic strictures were identified from endoscopy records. Case notes were reviewed to determine outcomes. Results: Fourteen patients underwent a total of 26 dilations, with triamcinolone injected (median dose 20 mg, 10-40 mg) in 20 of the procedures. Seven patients (50%) had sustained remission after a single dilation and steroid injection, with a median follow-up period of 16.4 months (range 13.2-22.0 months). Four patients (28.5%) required more than one dilation (median three dilations, range two to four) to control their symptoms, with a median follow-up period of 27.8 months (range 14-32.8 months). Endoscopic management failed in three patients (21.4%), who were referred for surgery. There were no complications due to dilation or triamcinolone injection. Conclusions: Triamcinolone injection into the stricture after dilation is safe, easy to perform, and may be a useful adjunct in the management of anastomotic Crohn's strictures. These data will require further support through a randomized and controlled trial.