P346. Endoscopic treatment of colonic strictures in ulcerative colitis (UC): Feasibility and effectiveness
J.A. Karagiannis1, K. Paraskeva1, N. Mathou1, A. Giannakopoulos1
1“Konstantopoulio” Hospital, Gastroenterology, Athens, Greece
Background: Stricture formation is a prominent feature of Crohn's disease, but colonic strictures may arise in patients with UC as well, particularly in patients with extensive (pancolitis) and long-standing disease. Stricture formation may cause clinical features of constipation and may also prevent surveillance colonoscopies, mandatory for detection of severe dysplasia or precancerous lesions.
Proctocolectomy with or without pouch formation consists a common approach, however there is a number of patients refusing surgical treatment in the absence of malignancy.
Methods: Aim of the study was to assess the feasibility and effectiveness of endoscopic dilatation of colonic strictures in patients with UC. Six patients (4 male, 2 female, age range 55–71 years) with extensive (pancolitis) long-standing (14–22 years) UC were diagnosed with single colonic strictures (2 in sigmoid, 2 in descenting, 1 in the splenic flexure and 1 in the proximal transverse colon) preventing further insertion of the endoscope. All were in clinical and endoscopic remission under 5‑ASA compounds and biopsies taken through-out the examined colon didn't show any evidence of severe dysplasia. The 2 patients with sigmoid strictures complained for mild to moderate constipation, while the rest 4 were asymptomatic. Their further work-up included double-contrast barium enema and CT colonography without any other abnormal findings, except from the strictures. The option of surgical management was proposed but was either refused (4 patients) or was reserved only if no other alternative was offered to them (2 patients). In all patients the option of endoscopic dilatation was discussed after explaining the risk of complications and/or failure of the procedure.
Results: Under concious sedation standard endoscopic dilatation was performed sucessfully in 5/6 patients (over-the-wire, with water-filled balloon-Rigiflex/Boston Scientific) under fluoroscopic guidence. In 1/6 with the splenic flexure stricture the procedure was unsucessful because of acute angulation of the bowel lumen. Immediately after dilatation colonoscopy was performed to the caecum. In 1/5 patients a DALM lesion was detected proximally to the stricture and was sucessfully excised endoscopically. Histopathology confirmed high-grade dysplasia and the patient underwent proctocolectomy with pouch formation.
Conclusions: Endoscopic dilatation of colonic strictures is feasible in the majority of patients with UC allowing full endoscopic examination of the large bowel.