[en] BACKGROUND: There are few data concerning patients with Crohn's disease (CD) complicated by a stricture of the upper gastrointestinal tract (UGT). AIMS: We evaluated the outcome and management of CD patients complicated by a stricture of the UGT. METHODS: We performed a retrospective multicenter study including all CD patients with a non-passable symptomatic UGT stricture on endoscopy. Primary outcome measure was surgery-free survival from diagnosis of stricture. Efficacy of medical, endoscopic, and surgical treatments, and identification of predictors of surgery were also evaluated. RESULTS: 60 CD patients with an UGT stricture were included. 60% of the strictures were located in the duodenum. With a median follow-up of 5.5 (IQR: 3.0-12.0) years since stricture diagnosis, surgical-free survival was 75% and 64% at 1 and 5 years, respectively. At the end of the follow up, 27 (45%) patients underwent surgery. 77 endoscopic procedures were performed in 30 patients with an immediate success of 81% and a clinical benefit in 84% of the procedures. In multivariate analysis, anti-TNF treatment initiation was associated with a reduced risk of surgery. CONCLUSION: CD UGT strictures are mainly located in the duodenum. Medical and endoscopic treatments allow to avoid surgery in half of the patients.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Lambin, Thomas; Department of Gastroenterology, Claude Huriez hospital, University of Lille, Lille, France.
Amiot, Aurélien; Department of Gastroenterology, Hopitaux Universitaires Henri Mondor, AP-HP, EA7375, Universite Paris Creteil, Creteil, France.
Stefanescu, Carmen; Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France.
Gornet, Jean-Marc; Department of Gastroenterology, Saint-Louis Hospital, Paris, France.
Laharie, David; CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France.
Reenaers, Catherine ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gastroentérologie, hépatologie, onco. digestive
Bourreille, Arnaud; University of Nantes, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Department of gastroenterology, Nantes, France.
Cadiot, Guillaume; Department of gastroenterology, Reims University Hospital, Reims, France.
Carbonnel, Franck; Department of gastroenterology, Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
Dib, Nina; Department of gastroenterology, Angers University Hospital, Angers, France.
Fumery, Mathurin; Department of gastroenterology, Amiens University Hospital, and Peritox UMR I-0I, Amiens, France.
Gilletta de St Joseph, Cyrielle; Department of gastroenterology, Rangueil Hospital, University of Toulouse 3, Toulouse, France.
Filippi, Jérôme; Department of gastroenterology, Nice University Hospital, Nice, France.
Viennot, Stéphanie; Department of gastroenterology, University Hospital of Caen, Caen, France.
Plastaras, Laurianne; Department of gastroenterology, Hospital Pasteur, Colmar, France.
Coffin, Benoit; Department of gastroenterology, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Serrero, Mélanie; Department of gastroenterology, Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France.
Nahon, Stéphane; Department of gastroenterology, GHI Le Raincy-Montfermeil, Montfermeil, France.
Pineton de Chambrun, Guillaume; Department of gastroenterology, Saint-Eloi Hospital, Montpellier University, Montpellier, France.
Rahier, Jean-François; Department of gastroenterology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium.
Roblin, Xavier; Department of gastroenterology, Saint-Etienne University Hospital, Saint-Étienne, France.
Boualit, Médina; Department of gastroenterology, Valenciennes General Hospital, Valenciennes, France.
Bouguen, Guillaume; Department of Endoscopy and Gastroenterology, Pontchaillou University Hospital, Rennes, France.
Peyrin-Biroulet, Laurent; Department of gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France.
Pariente, Benjamin; Department of Gastroenterology, Claude Huriez hospital, University of Lille, Lille, France, Inserm Unit 995, University of Lille 2, Lille, France. Electronic address: benjamin.pariente@chru-lille.fr.
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