{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:05:56Z","timestamp":1789765556930,"version":"4.0.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Spanish National Institute of Health"},{"name":"Foundation of Spanish Society of Digestive Endoscopy"},{"name":"Catalan Society of Gastroenterology"},{"name":"Taewoong"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>At 1-year of follow-up, the ProtDilat trial indicated that endoscopic balloon dilatation (EBD) was more effective than self-expandable metal stents (SEMSs) for treating Crohn\u2019s disease (CD) strictures. We aimed to assess the long-term outcomes of ProtDilat participants, focusing on surgery-free rates, factors related to surgery, and endoscopic retreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively collected data on medical treatment, endoscopic\u2013surgical interventions, and smoking status. The primary outcome was the percentage of patients who remained free of surgery at the end of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty participants were included (39 SEMS, 41 EBD); 39 were women and the median age was 45\u2009years (IQR: 38-55). Over a 7-year follow-up (median 77\u2009months; IQR 61-84), 31.5% (25\/80) of patients required surgery, with a median time to surgery of 30.6\u2009months (IQR 6.4-55.2). Surgery-protective factors were no-intensification of medical therapy (HR 0.22 [0.08-0.58]), EBD treatment (HR 0.26 [0.10-0.68]), and single endoscopic treatment (HR 0.33 [0.15-0.74]). Among the 55 patients who avoided surgery, the median number of endoscopic treatments was two. Notably, 36.3% (29\/80) required neither surgery nor endoscopic retreatment. Among the 53 patients (20 SEMS vs 33 EBD) with successful initial endoscopic treatment in the ProtDilat, the long-term effectiveness (free of surgery and endoscopic retreatment) was 45% and 57.6% respectively (P\u2009=\u2009.374). Treatment-related adverse events occurred in 8.75% (7\/80) of endoscopic cases vs 36% (9\/25) of surgical cases (P\u2009=\u2009.003), with a severity (AGREE\/Clavien\u2013Dindo\u2009\u2265\u20093) of 38% (3\/8) vs 84% (10\/12), respectively (P\u2009=\u2009.011).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Endoscopic approaches (especially EBD) are effective long-term therapies for avoiding surgery and requiring few endoscopic treatments. Stable medical management and single EBD therapy were independently associated with a lower likelihood of surgery during follow-up. Our findings also highlight the higher frequency and severity of adverse events associated with surgical intervention compared to endoscopic management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjag112","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:37:24Z","timestamp":1784029044000},"source":"Crossref","is-referenced-by-count":0,"title":["Se\n                    <scp>lf-<\/scp>\n                    expandable metal stents versus endoscopic balloon dilatation for the treatment of strictures in Crohn\u2019s disease: a retrospective lo\n                    <scp>ng-<\/scp>\n                    term foll\n                    <scp>ow-<\/scp>\n                    up of the ProtDilat study, an open label, multicenter, randomized trial"],"prefix":"10.1093","volume":"20","author":[{"given":"Carme","family":"Loras","sequence":"first","affiliation":[{"name":"Digestive Diseases Department, Hospital Universitari M\u00fatua Terrassa , Terrassa,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd) , Madrid,","place":["Spain"]},{"name":"Universitat de Barcelona (UB) , Barcelona,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6766-3069","authenticated-orcid":false,"given":"Pablo","family":"Ruiz-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Digestive Diseases Department, Hospital Universitari M\u00fatua Terrassa , Terrassa,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd) , Madrid,","place":["Spain"]},{"name":"Universitat de Barcelona (UB) , Barcelona,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan B","family":"Gornals","sequence":"additional","affiliation":[{"name":"Universitat de Barcelona (UB) , Barcelona,","place":["Spain"]},{"name":"Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge , Barcelona,","place":["Spain"]},{"name":"Bellvitge Biomedical Research Institute (IDIBELL) , Barcelona,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Sanchiz","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico Universitario de Valencia , Valencia,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Brunet-Mas","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd) , Madrid,","place":["Spain"]},{"name":"Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Parc Taul\u00ed Hospital Universitari , Sabadell,","place":["Spain"]},{"name":"Departament de Medicina, Universitat Aut\u00f2noma de Barcelona , Barcelona,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Iglesias","sequence":"additional","affiliation":[{"name":"Hospital Universitario Reina Sof\u00eda, IMIBIC, UCO , C\u00f3rdoba,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Barrio","sequence":"additional","affiliation":[{"name":"Servicio de Gastroenterolog\u00eda, Hospital Universitario R\u00edo Hortega, Gerencia Regional de Salud de Castilla y Le\u00f3n (SACYL) , Valladolid,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Sicilia","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Burgos , Burgos,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Due\u00f1as","sequence":"additional","affiliation":[{"name":"Hospital San Pedro de Alc\u00e1ntara , 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