Dilation vs Surgery

[JenniLenni]

I'd love to hear some other's experience with stricture dilation.

I have been diagnosed with Crohn's since about age 10; I am now 31. I have had two bowel reactions. The first was only a handful of years after being diagnosed. The second was five years ago.

September of last year I had a bad flare, was in the hospital for a few days. Crohn's got in control with Imuran, asacol, and a strict diet. (Steroids make my vision flurry.. Even on low dose.) What I am battled now is a stricture from scar tissue at my previous surgery site, where my small and large bowels connect.

Three weeks ago my doctor dilated the stricture. The first week was PERFECT. My BM's were more formed and regular, no pains, and I could feel my energy coming back. However, a week ago I started getting waves of pain worse than I have ever had. I can tell the stricture is back, worse than before.

My GI doc wants to do a second dilation.. But I am leaning more toward surgery. Everything I have read says dialations are temporary and help prolong surgery. At this point, I've lost 25lb since September, I have no energy, I can't sleep or eat much... I am over it.

Any one relate?

 

[24601]

Hi! Welcome to the forum!

I've never had a dilatation myself as I have always had strictures throughout the jejunum and ileum so I've always needed surgery to perform strictureplasties and/or resect the scarred and narrowed sections.

I don't know if your quick recurrence of symptoms is predictive of a similar outcome from repeated dilation attempts but I can understand why you would be put off repeating the procedure given the very short-term effect for you. I have read that it is common to need repeated dilatation - one study says 46% require this with 24% needing surgery. Source Another study here says, I believe, that 90% of patients were surgery free at 12 months, 75% at 24 months and 53% at 36 months - so as you say for a large proportion of patients dilation may just delay surgery. And as I understand it repeated dilations were necessary to achieve those results. In that paper they say they repeated dilation at 1 week intervals until adequate dilatation was achieved - so it does sound like it's in no way unusual to need repeated dilation so quickly and can be considered part of the treatment plan, rather than a failure of the method. They also say that better results are achieved with anastomotic strictures like yours, so that is perhaps encouraging. And certainly it would seem that some do avoid further suurgery using this technique.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542755/

How are your inflammation levels now? Does your doctor think there is any inflammatory component to this stricture? Or inflammation elsewhere in your bowel? If there is it might be useful to get that inflammation under control before surgery and it may help reduce your symptoms.

I'm wondering if a biologic like Remicade or Humira might be useful, either to get you fully into remission, or to use after this next surgery, if you go ahead, or even if you go ahead with the dilation to put you in the best position to avoid further surgeries.

Good luck with your decision

 

[JenniLenni]

Thank you for the thorough response. I've done a lot of reading on the research out there about dilation. You mentioned some articles that I haven't read yet, so I will check into those.

After talking with my doctor two days ago, we decided to proceed with surgery. I am scheduled for a surgeon consult in about a week. I want to ask about strictureplasty; I've also done some reading on that. I just can't see going back in to keep stretching - the prep that often sounds horrible along with the financial aspect. I want my life to get back to "normal" and it seems this would be the most sure way.

And to follow up... I am officially in remission. My blood work and colonoscopy show no signs of inflammation. This is all strictly scare tissue related.

Again - Thank you for the response!

 

[24601]

No worries! That's great that you are in remission. And I completely understand about not wanting to repeat the prep and also deal with the roughly 10% chance of perforation (seen in some studies) with each dilation, for a fairly even chance of ending up needing surgery anyway.

Good luck with that! Hopefully they can perform a strictureplasty on this stricture and you can enjoy a long remission free from the symptoms caused by this stricture!