Enter your Email address:
Wolters Kluwer Health may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
You currently have no recent searches
Quiros, JA1; Quan, R1; Malloy, F1; Tennyson, L1; Picornell, Y3; Dubinsky, M3; Thomas, Prindiville2
1Dept. of Pediatrics UC Davis Childrens Hospital
2Dept. of Internal Medicine UC Davis Medical Center, Sacramento CA, USA
3Pediatric IBD Center, Cedars Sinai Medical Center, Los Angeles CA, USA
Fibro-stenosing disease is the primary reason for surgery in 20% of Crohn's patients. Post-operative recurrence rates can be seen in >50% of patients. The presence of NOD mutations has been associated with fibro-stenosing disease in adult cohorts but the same hasn't been noted in children. Endoscopy offers a minimally invasive option for management of these cases and there is no long-term safety and efficacy data in pediatric patients. The possible cost-saving implications of this strategy also need to be taken into account.
Six patients in our clinical practice developed fibro-stenosing disease in areas amenable to endoscopic examination. Of these, 5 proceeded to endoscopic dilatation, after a thorough discussion with the family about the risks and benefits of endoscopic management and one was sent to surgical resection due to long segment length.
Five subjects underwent 9 serial hydrostatic balloon dilatations. 4 had simple strictures while 1 patient had a complex stricture (4 strictures) in the ileum which was unknown until the time of endoscopy. NOD genetic analysis was performed in 4 patients and 2 were found to have a mutant allele present. EUS examination of all the stricture tracks was performed prior to dilatations to rule out external compression, mural fluid collections or other pathology. All patients were kept on parenteral nutrition and/or low residue diet while they underwent therapy. Triamcinolone 40 mg was injected into the strictures prior to dilatation.
Average post-op follow up for all patients is 438 days and no complications directly related to the procedures have been reported. One patient done under propofol sedation developed aspiration pneumonia. One patient was sent to surgery after 1 dilatation due to poor compliance with therapy and underwent a hemicolectomy. All patients reported symptomatic improvement after dilatation. Endoscopic management is a viable and safe option in the treatment of Crohn's associated fibro-stenosing disease in children (see Table 1).
© 2006 Lippincott Williams & Wilkins, Inc.
Colleague's E-mail is Invalid
Your Name: (optional)
Separate multiple e-mails with a (;).
Thought you might appreciate this item(s) I saw at Journal of Pediatric Gastroenterology and Nutrition.
Send a copy to your email
Your message has been successfully sent to your colleague.
Some error has occurred while processing your request. Please try after some time.
An Existing Folder
A New Folder
The item(s) has been successfully added to "".
Login with your LWW Journals username and password.
Username or Email:
Enter and submit the email address you registered with. An email with instructions to reset your password will be sent to that address.
Link to reset your password has been sent to specified email address.
What does "Remember me" mean?
By checking this box, you'll stay logged in until you logout. You'll get easier access to your articles, collections,
media, and all your other content, even if you close your browser or shut down your
To protect your most sensitive data and activities (like changing your password),
we'll ask you to re-enter your password when you access these services.
What if I'm on a computer that I share with others?
If you're using a public computer or you share this computer with others, we recommend
that you uncheck the "Remember me" box.
Save my selection
Visit JPGN.org on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.