Is local injection of mesenchymal stem cells after endoscopic dilation safe and does it improve the outcome of intestinal stricture in patients with Crohn's disease?

Korábbi kezelés

• Patient liable for immediate surgery
• Patient having presented an opportunistic infection in the 6 months preceding inclusion or a serious infection in the previous 3 months
• Patient who has developed a malignant tumor with a history of lymphoproliferative disease with the exception of: non-melanoma skin cancer, carcinoma in situ (e.g. skin, cervix, bladder, breast) and in remission for at least 3 years prior to screening, superficial bladder cancer, asymptomatic low-grade or localized curatively treated prostate cancer for which the “watch-and-wait” approach is the standard of care as well as any other cancer that has been in remission for ≥ 3 years prior to enlistment.

Más betegség

• Patient with intra-abdominal fistula or abscess
• Patient with documented human immunodeficiency virus (HIV) infection, active hepatitis B or C, or tuberculosis

Laborértékek

• Patient with kidney insufficiency (with anuria, GFR or glomerular filtration rate < 30 ml/min or on dialysis), hepatic insufficiency (presence of fulminant hepatitis, cirrhosis with signs of portal hypertension, acute alcoholic hepatitis, esophageal varices, history of gastrointestinal bleeding following rupture of esophageal varices, hepatic encephalopathy, prolonged prothrombin time, ascite secondary to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with a total serum bilirubin level > 3 mg/dL)

Egyéb

• Patient with a stenosis not accessible to ileo-colonoscopy
• Patient presenting ≥ 2 strictures with impossibility of determining which stenosis is "dominant" and responsible for the symptoms (based on dilation at Magnetic Resonance Enterography)
• Patient with stricture longer than 5 cm
• Patient with a contraindication to performing a Magnetic Resonance Enterography (MRE) or to the use of contrast product injection in MRE (Gadolinium)
• Pregnant woman or planning a pregnancy in the year

• Patient aged ≥ 18 years with Crohn's Disease diagnosed more than 6 months ago
• Background Crohn's Disease treatment stable for 4 months
• Presence of stricture (whether de novo or anastomotic), meeting the radiological definition of stenosis, i.e. a combination of the following criteria: (1) localized luminal narrowing (reduction of luminal diameter by at least less than 50% compared to adjacent healthy bowel segment), (2) bowel wall thickening (25% increase in wall thickness compared to adjacent unaffected bowel) and pre-stenotic dilation (luminal diameter greater than 3 cm)
• Presence of symptomatic stricture with abdominal pain after meals and limitations on the amount or type of food at screening
• Presence of a stenosis accessible by ileo-colonoscopy, not passable (i.e. not allowing the passage of the adult ileo-colonoscope), of a length less than 5 cm, eligible for endoscopic dilation
• Patient accepting the study protocol and having signed an informed consent
• Patient capable of undergoing a Magnetic Resonance Enterography with Dynamic-Contrast-Enhancement (DCE-MRI)