Tratamiento endoscópico mediante inyección tópica de infliximab en estenosis inflamatorias en la enfermedad de Crohn

Introduction

Inflammatory and postsurgical stenosis of Crohn's disease (EC) can cause occlusive symptoms difficult to manage. Optimizing medical treatment and endoscopic dilatation is usually necessary; although sometimes the definitive treatment is surgery. The objective of this study is to evaluate the efficacy of local infliximab injection in patients with Crohn's disease with inflammatory stenosis (primary or postsurgical) in our center.

Material and methods

17 patients were included prospectively. Inclusion criteria: Crohn's disease with occlusive symptoms, inflammatory stenosis less than 5 cm length studied by MR, non permeable with normal colonoscopy. 30 mg of infliximab were injected in each endoscopic session, in all 4 sides of stenosis. The sessions were repeated with a median of 6 weeks.

Results

17 patients (12 male, 5 female). Median age: 44.1 years old. Median evolution of disease: 12.2 years. Stenosis of the anastomosis: 64.7%, primary stenosis: 35.3% (2 ileal, 2 colon, 1 pyloric, 1 stoma). 88.2% were treated with biological drugs. Median number of endoscopic sessions: 4, R (1-12). 3 pneumatic dilatation. Complete response: 35.3%; partial response: 41.1%; non response: 23.5%. Responders have maintain sustained response along a median follow up of 23.3 months. No adverse events have been registered.

Conclusion

Topical injection of infliximab in luminal stenosis of Crohn's disease can be a complementary therapy to endoscopic dilatation and an alternative for surgery; safe and well tolerated.