Background
Methods
Patients
Endoscopic procedure and evaluation
Measurements
Analysis
Results
Patient demographics
Variables | Total | Presence of ulcer at the stricture | p value | |
---|---|---|---|---|
No | Yes | |||
98 (100.0%) | 35 (35.7%) | 63 (64.3%) | ||
Baseline characteristics | ||||
Sex, n (%) | ||||
Men | 76 (77.6%) | 26 (74.3%) | 50 (79.4%) | 0.618† |
Women | 22 (22.4%) | 9 (25.7%) | 13 (20.6%) | |
Median age at diagnosis of CD, years (range) | 28 (3, 63) | 30 (12, 63) | 27 (3, 60) | |
Age at diagnosis of CD, n (%) | ||||
< 17 | 10 (10.2%) | 4 (11.4%) | 6 (9.5%) | 1.000† |
17–40 | 70 (71.4%) | 25 (71.4%) | 45 (71.4%) | |
> 40 | 18 (18.4%) | 6 (17.1%) | 12 (19.1%) | |
Median disease duration, years (range) | 4.64 (0.00, 32.57) | 3.00 (0.00, 31.99) | 7.13 (0.00, 32.57) | |
Smoking, n (%) | ||||
Never | 70 (71.4%) | 23 (65.7%) | 47 (74.6%) | 0.470† |
Current | 16 (16.3%) | 8 (22.9%) | 8 (12.7%) | |
Ex-smoker | 12 (12.2%) | 4 (11.4%) | 8 (12.7%) | |
Previous intestinal resection, n (%) | ||||
No | 61 (62.2%) | 28 (80.0%) | 33 (52.4%) | 0.009†* |
Yes | 37 (37.8%) | 7 (20.0%) | 30 (47.6%) | |
Perianal involvement, n (%) | ||||
No | 64 (65.3%) | 28 (80.0%) | 36 (57.1%) | 0.027†* |
Yes | 34 (34.7%) | 7 (20.0%) | 27 (42.9%) | |
Disease location, n (%) | ||||
L1 | 54 (55.1%) | 22 (62.9%) | 32 (50.8%) | 0.250‡ |
L3 | 44 (44.9%) | 13 (37.1%) | 31 (49.2%) | |
Median CDAI score, (range) | 78.32 (0.00, 383.52) | 63.84 (0.00, 198.97) | 84.00 (0.00, 383.52) | |
CDAI score, n (%) | ||||
< 150 | 79 (80.6%) | 31 (88.6%) | 48 (76.2%) | 0.185† |
≥ 150 | 19 (19.4%) | 4 (11.4%) | 15 (23.8%) | |
Median CRP, mg/L (range) | 1.1 (0.2, 66.4) | 1.0 (0.2, 13.2) | 1.2 (0.2, 66.4) | |
CRP, n (%) | ||||
≤ 4 mg/L | 77 (78.6%) | 32 (91.4%) | 45 (71.4%) | 0.022†* |
> 4 mg/L | 21 (21.4%) | 3 (8.6%) | 18 (28.6%) | |
Endoscopic findings | ||||
Stricture length, n (%) | ||||
< 2 cm | 92 (93.9%) | 32 (91.4%) | 60 (95.2%) | 0.663† |
≥ 2 cm | 6 (6.1%) | 3 (8.6%) | 3 (4.8%) | |
Anastomotic site stricture, n (%) | ||||
No | 89 (90.8%) | 31 (88.6%) | 58 (92.1%) | 0.717† |
Yes | 9 (9.2%) | 4 (11.4%) | 5 (7.9%) | |
Location of stricture, n (%) | ||||
TI | 21 (21.4%) | 8 (22.9%) | 13 (20.6%) | 0.933† |
PI | 71 (72.4%) | 25 (71.4%) | 46 (73.0%) | |
J | 6 (6.1%) | 2 (5.7%) | 4 (6.3%) | |
Concomitant treatment | ||||
Corticosteroid, n (%) | ||||
No | 87 (88.8%) | 31 (88.6%) | 56 (88.9%) | 1.000† |
Yes | 11 (11.2%) | 4 (11.4%) | 7 (11.1%) | |
5-aminosalicylate, n (%) | ||||
No | 35 (35.7%) | 14 (40.0%) | 21 (33.3%) | 0.509‡ |
Yes | 63 (64.3%) | 21 (60.0%) | 42 (66.7%) | |
Anti-TNF, n (%) | ||||
No | 51 (52.0%) | 17 (48.6%) | 34 (54.0%) | 0.608‡ |
Yes | 47 (48.0%) | 18 (51.4%) | 29 (46.0%) | |
Immunomodulator, n (%) | ||||
No | 60 (61.2%) | 24 (68.6%) | 36 (57.1%) | 0.266‡ |
Yes | 38 (38.8%) | 11 (31.4%) | 27 (42.9%) | |
Anti-TNF + Immunomodulator, n (%) | ||||
No | 80 (81.6%) | 29 (82.9%) | 51 (81.0%) | 1.000† |
Yes | 18 (18.4%) | 6 (17.1%) | 12 (19.0%) | |
Endoscopic treatment | ||||
Balloon dilation diameter, n (%) | ||||
< 15 mm | 51 (52.0%) | 12 (34.3%) | 39 (61.9%) | 0.009‡* |
≥ 15 mm | 47 (48.0%) | 23 (65.7%) | 24 (38.1%) | |
Outcome | ||||
Surgery | ||||
No | 74 (75.5%) | 31 (88.6%) | 43 (68.3%) | 0.029†* |
Yes | 24 (24.5%) | 4 (11.4%) | 20 (31.7%) |
Association between ulcer at the stricture and surgical risk
Variables at diagnosis | Case of surgery, n | Person-days of follow-up, mean | Univariate | Multivariate | |||||
---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | p value | HR | 95% CI | p value | ||||
Sex | |||||||||
Men | ref | 14 | 1217.974 | 1.00 | 1.00 | ||||
Women | 10 | 1124.727 | 2.56 | 1.14, 5.77 | 0.023* | 1.95 | 0.74, 5.13 | 0.176 | |
Age at diagnosis of CD | |||||||||
< 17 | 2 | 1014.3 | 1.00 | 0.23, 4.37 | 0.997 | 0.55 | 0.09, 3.31 | 0.509 | |
17–40 | ref | 16 | 1171.543 | 1.00 | 1.00 | ||||
40 < | 6 | 1397.722 | 1.29 | 0.50, 3.30 | 0.594 | 1.12 | 0.42, 2.98 | 0.816 | |
Smoking | |||||||||
Never | ref | 18 | 1160.5 | 1.00 | |||||
Current | 4 | 1209 | 0.95 | 0.32, 2.82 | 0.930 | ||||
Ex-smoker | 2 | 1394.25 | 0.55 | 0.13, 2.39 | 0.428 | ||||
Previous intestinal resection | |||||||||
No | ref | 19 | 1172.721 | 1.00 | 1.00 | ||||
Yes | 5 | 1237.135 | 0.41 | 0.15, 1.09 | 0.074 | 0.26 | 0.09, 0.76 | 0.014* | |
Perianal involvement | |||||||||
No | ref | 15 | 1336.688 | 1.00 | |||||
Yes | 9 | 934.1765 | 1.34 | 0.59, 3.08 | 0.484 | ||||
Disease location | |||||||||
L1 | ref | 14 | 1209.944 | 1.00 | |||||
L3 | 10 | 1181.205 | 0.93 | 0.41, 2.09 | 0.853 | ||||
CDAI score | |||||||||
< 150 | ref | 16 | 1289.013 | 1.00 | 1.00 | ||||
≥ 150 | 8 | 814.6316 | 2.91 | 1.23, 6.84 | 0.015* | 1.83 | 0.62, 5.41 | 0.273 | |
CRP | |||||||||
≤ 4 mg/L | ref | 17 | 1243.896 | 1.00 | |||||
> 4 mg/L | 7 | 1025.238 | 1.63 | 0.68, 3.94 | 0.275 | ||||
Endoscopic finding | |||||||||
Stricture length | |||||||||
< 2 cm | ref | 21 | 1239.076 | 1.00 | 1.00 | ||||
≥ 2 cm | 3 | 552.5 | 3.14 | 0.91, 10.81 | 0.069 | 3.31 | 0.68, 15.99 | 0.137 | |
Anastomotic site stricture | |||||||||
No | ref | 22 | 1189.899 | 1.00 | |||||
Yes | 2 | 1267.667 | 0.85 | 0.20, 3.64 | 0.831 | ||||
Location of stricture | |||||||||
TI | ref | 9 | 1250.667 | 1.00 | |||||
PI | 15 | 1138.563 | 0.52 | 0.22, 1.19 | 0.123 | ||||
J | 0 | 1701.333 | |||||||
Presence of ulcer at the stricture | |||||||||
No | ref | 4 | 1406.714 | 1.00 | 1.00 | ||||
Yes | 20 | 1080.556 | 3.19 | 1.08, 9.34 | 0.035* | 4.84 | 1.58, 14.79 | 0.006* | |
Concomitant treatment | |||||||||
Corticosteroid | |||||||||
No | ref | 22 | 1244.345 | 1.00 | |||||
Yes | 2 | 822.9091 | 0.90 | 0.21, 3.84 | 0.883 | ||||
5-aminosalicylate | |||||||||
No | ref | 11 | 1126.629 | 1.00 | |||||
Yes | 13 | 1236.159 | 0.64 | 0.29, 1.42 | 0.271 | ||||
Anti-TNF | |||||||||
No | ref | 15 | 1188.824 | 1.00 | |||||
Yes | 9 | 1205.957 | 0.62 | 0.27, 1.41 | 0.253 | ||||
Immunomodulator | |||||||||
No | ref | 15 | 1218.05 | 1.00 | |||||
Yes | 9 | 1163.868 | 1.04 | 0.46, 2.39 | 0.918 | ||||
Anti-TNF + Immunomodulator | |||||||||
No | ref | 20 | 1190.912 | 1.00 | |||||
Yes | 4 | 1224.278 | 0.91 | 0.31, 2.67 | 0.863 |
Association between ulcer at the stricture and redilation at follow-up BAE
Total | Presence of ulcer at the stricture | p value | ||
---|---|---|---|---|
No | Yes | |||
Variables | 71 (100.0%) | 27 (38.0%) | 44 (62.0%) | |
Baseline | ||||
Sex, n (%) | ||||
Men | 58 (81.7%) | 22 (81.5%) | 36 (81.8%) | 1.000† |
Women | 13 (18.3%) | 5 (18.5%) | 8 (18.2%) | |
Median age at diagnosis of CD, years (range) | 28 (3, 63) | 32 (12, 63) | 27 (3, 60) | |
Age at diagnosis of CD, n (%) | ||||
< 17 | 8 (11.3%) | 4 (14.8%) | 4 (9.1%) | 0.645† |
17–40 | 49 (69.0%) | 17 (63.0%) | 32 (72.7%) | |
> 40 | 14 (19.7%) | 6 (22.2%) | 8 (18.2%) | |
Median disease duration, years (range) | 5.41 (0.00, 32.58) | 3.53 (0.12, 31.99) | 7.41 (0.00, 32.58) | |
Smoking, n (%) | ||||
Never | 48 (67.6%) | 17 (63.0%) | 31 (70.5%) | 0.439† |
Current | 13 (18.3%) | 7 (25.9%) | 6 (13.6%) | |
Ex-smoker | 10 (14.1%) | 3 (11.1%) | 7 (15.9%) | |
Previous intestinal resection, n (%) | ||||
No | 43 (60.6%) | 22 (81.5%) | 21 (47.7%) | 0.006†* |
Yes | 28 (39.4%) | 5 (18.5%) | 23 (52.3%) | |
Perianal involvement, n (%) | ||||
No | 48 (67.6%) | 22 (81.5%) | 26 (59.1%) | 0.068† |
Yes | 23 (32.4%) | 5 (18.5%) | 18 (40.9%) | |
Disease location, n (%) | ||||
L1 | 40 (56.3%) | 17 (63.0%) | 23 (52.3%) | 0.378‡ |
L3 | 31 (43.7%) | 10 (37.0%) | 21 (47.7%) | |
Median CDAI score, (range) | 76.8 (0.00, 269.2) | 68.99 (3.94, 198.2) | 79.2 (0.00, 269.2) | |
CDAI score, n (%) | ||||
< 150 | 62 (87.3%) | 25 (92.6%) | 37 (84.1%) | 0.467† |
≥ 150 | 9 (12.7%) | 2 (7.4%) | 7 (15.9%) | |
Median CRP at time of EBD, mg/L (range) | 0.8 (0.2, 66.4) | 0.8 (0.2, 13.2) | 0.8 (0.2, 66.4) | |
CRP at time of EBD, n (%) | ||||
≤ 4 mg/L | 56 (78.9%) | 25 (92.6%) | 31 (70.5%) | 0.036†* |
> 4 mg/L | 15 (21.1%) | 2 (7.4%) | 13 (29.5%) | |
Endoscopic findings | ||||
Stricture length, n (%) | ||||
< 2 cm | 67 (94.4%) | 24 (88.9%) | 43 (97.7%) | 0.151† |
≥ 2 cm | 4 (5.6%) | 3 (11.1%) | 1 (2.3%) | |
Anastomotic site stricture, n (%) | ||||
No | 64 (90.1%) | 25 (92.6%) | 39 (88.6%) | 0.701† |
Yes | 7 (9.9%) | 2 (7.4%) | 5 (11.4%) | |
Location of stricture, n (%) | ||||
TI | 16 (22.5%) | 6 (22.2%) | 10 (22.7%) | 0.777† |
PI | 50 (70.4%) | 20 (74.1%) | 30 (68.2%) | |
J | 5 (7.0%) | 1 (3.7%) | 4 (9.1%) | |
Concomitant treatment | ||||
Corticosteroid, n (%) | ||||
No | 62 (87.3%) | 23 (85.2%) | 39 (88.6%) | 0.723† |
Yes | 9 (12.7%) | 4 (14.8%) | 5 (11.4%) | |
5-aminosalicylate, n (%) | ||||
No | 25 (35.2%) | 10 (37.0%) | 15 (34.1%) | 0.801‡ |
Yes | 46 (64.8%) | 17 (63.0%) | 29 (65.9%) | |
Anti-TNF, n (%) | ||||
No | 35 (49.3%) | 13 (48.1%) | 22 (50.0%) | 0.880‡ |
Yes | 36 (50.7%) | 14 (51.9%) | 22 (50.0%) | |
Immunomodulator, n (%) | ||||
No | 45 (63.4%) | 18 (66.7%) | 27 (61.4%) | 0.801† |
Yes | 26 (36.6%) | 9 (33.3%) | 17 (38.6%) | |
Anti-TNF + Immunomodulator, n (%) | ||||
No | 59 (83.1%) | 23 (85.2%) | 36 (81.8%) | 1.000† |
Yes | 12 (16.9%) | 4 (14.8%) | 8 (18.2%) | |
Endoscopic treatment and follow-up time | ||||
Balloon dilation diameter, n (%) | ||||
< 15 mm | 35 (49.3%) | 7 (25.9%) | 28 (63.6%) | 0.003†* |
≥ 15 mm | 36 (50.7%) | 20 (74.1%) | 16 (36.4%) | |
Median time between EBD and follow-up endoscopy, days (range) | 371 (89, 1843) | 369 (130, 1843) | 372 (89, 1163) | 0.619§ |
Outcome | ||||
Redilation at follow-up endoscopy | ||||
No | 18 (25.4%) | 12 (44.4%) | 6 (13.6%) | 0.005†* |
Yes | 53 (74.6%) | 15 (55.6%) | 38 (86.4%) |
Variables at diagnosis | Case of redilation, n | Univariate | Multivariate | |||||
---|---|---|---|---|---|---|---|---|
OR | 95% CI | p value | OR | 95% CI | p value | |||
Sex | ||||||||
Men | ref | 44 | 1.00 | 1.00 | ||||
Women | 9 | 0.72 | 0.19, 2.69 | 0.620 | 0.56 | 0.13, 2.45 | 0.445 | |
Age at diagnosis of CD | ||||||||
< 17 | 7 | 2.27 | 0.25, 20.37 | 0.464 | 3.81 | 0.35, 40.91 | 0.270 | |
17–40 | ref | 37 | 1.00 | 1.00 | ||||
40 < | 9 | 0.58 | 0.16, 2.08 | 0.407 | 0.62 | 0.15, 2.47 | 0.495 | |
Smoking | ||||||||
Never | ref | 37 | 1.00 | |||||
Current | 8 | 0.48 | 0.13, 1.75 | 0.264 | ||||
Ex-smoker | 8 | 1.19 | 0.22, 6.44 | 0.841 | ||||
Previous intestinal resection | ||||||||
No | ref | 32 | 1.00 | |||||
Yes | 21 | 1.03 | 0.34, 3.09 | 0.956 | ||||
Perianal involvement | ||||||||
No | ref | 35 | 1.00 | |||||
Yes | 18 | 1.34 | 0.41, 4.34 | 0.629 | ||||
Disease location | ||||||||
L1 | ref | 28 | 1.00 | |||||
L3 | 25 | 1.79 | 0.58, 5.47 | 0.310 | ||||
CDAI score | ||||||||
< 150 | ref | 47 | 1.00 | |||||
≥ 150 | 6 | 0.64 | 0.14, 2.87 | 0.558 | ||||
CRP at time of EBD | ||||||||
≤ 4 mg/L | ref | 42 | 1.00 | |||||
> 4 mg/L | 11 | 0.92 | 0.25, 3.34 | 0.895 | ||||
Endoscopic findings | ||||||||
Stricture length | ||||||||
< 2 cm | ref | 51 | 1.00 | |||||
≥ 2 cm | 2 | 0.31 | 0.04, 2.41 | 0.265 | ||||
Anastomotic site stricture | ||||||||
No | ref | 48 | 1.00 | |||||
Yes | 5 | 0.83 | 0.15, 4.72 | 0.837 | ||||
Location of stricture | ||||||||
TI | ref | 14 | 1.00 | |||||
PI | 35 | 0.33 | 0.07, 1.65 | 0.178 | ||||
J | 4 | 0.57 | 0.04, 8.05 | 0.678 | ||||
Presence of ulcer at the stricture | ||||||||
No | ref | 15 | 1.00 | 1.00 | ||||
Yes | 38 | 5.07 | 1.61, 15.97 | 0.006* | 5.69 | 1.72, 18.80 | 0.004* | |
Concomitant treatment | ||||||||
Corticosteroid | ||||||||
No | ref | 47 | 1.00 | |||||
Yes | 6 | 0.64 | 0.14, 2.87 | 0.558 | ||||
5-aminosalicylate | ||||||||
No | ref | 19 | 1.00 | |||||
Yes | 34 | 0.89 | 0.29, 2.77 | 0.847 | ||||
Anti-TNF | ||||||||
No | ref | 24 | 1.00 | |||||
Yes | 29 | 1.90 | 0.64, 5.65 | 0.249 | ||||
Immunomodulator | ||||||||
No | ref | 31 | 1.00 | |||||
Yes | 22 | 2.48 | 0.72, 8.57 | 0.150 | ||||
Anti-TNF + Immunomodulator | ||||||||
No | ref | 42 | 1.00 | |||||
Yes | 11 | 4.45 | 0.53, 37.2 | 0.168 |