Endoscopic Balloon Dilation Versus Endoscopic Stricturotomy for Short Crohn's Disease Strictures: The BEST-CD Randomized Trial
In brief
Stricturotomy halves repeat treatment for short Crohn's strictures at one year
In a randomized trial of 106 adults, 24.5% treated with endoscopic stricturotomy needed reintervention within a year, compared with 49.1% after balloon dilation; clinical recurrence was also lower, 30.1% versus 54.7%. Adverse events were similar, but surgery rates did not differ significantly. The results favor stricturotomy in expert centers, though multicenter studies are needed to confirm them.
- Journal
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Q1)
- Published
- 28 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Partha Pal, Kanapuram Pooja, Syed Misba Naaz, Uday Kumar Marri, Pradeep Rebala, Rajesh Gupta, et al.
- PMID
- 42950934
- DOI
- 10.1016/j.cgh.2026.10.012
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 29 October 2026): endoscopic stricturotomy reduced 1‑year recurrence
Abstract
BACKGROUND AND AIMS: Endoscopic balloon dilation (EBD) is the standard therapy for Crohn's disease (CD) strictures but is limited by recurrence and reinterventions. Randomized comparative data on endoscopic stricturotomy (ES) vs EBD are lacking. METHODS: In this randomized controlled trial, adults (18-65 years) with symptomatic CD and short (<3 cm) strictures accessible by standard endoscopy were randomly assigned (1:1) to EBD or ES. The primary outcome was clinical recurrence at 1 year. Secondary outcomes at 1 year included reintervention, surgery, and stricture-related emergency visits and hospitalisation; safety was assessed at 30 days. Time-to-event analyses were censored at 12 months. RESULTS: Of 164 patients screened, 106 were randomised (EBD n=53; ES n=53). In the intention-to-treat population, clinical recurrence at 1 year was lower with ES than EBD (30.1% vs 54.7%; p=0·01), as were reintervention (24.5% vs 49.1%; p=0·01), emergency visits (18.9% vs 50.9%; p=0·001), and hospitalisations (15.1% vs 34%; p=0·02). Surgery did not differ significantly (1.9% vs 11.3%; p=0·11). In 12-month time-to-event analyses, EBD was associated with higher hazards of clinical recurrence (HR 2.27, 95% CI 1.23-4.18) and reintervention (HR 2.40, 95% CI 1.23-4.68), with consistent findings for emergency visits and hospitalisation. Adverse events were similar (13·2% vs 22.6%; p=0·30). CONCLUSION: ES was associated with lower 1-year clinical recurrence and reintervention than EBD for short CD strictures. These findings support ES as a promising endoscopic strategy in expert centres and warrant validation in multicentre studies. (ClinicalTrials.gov: NCT05521867).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.