P350. Long term outcome of endoscopic balloon dilatation of anastomotic strictures in patients with Crohn's disease
K. Nanda1, W. Courtney1, D. Keegan1, K. Byrne1, B. Nolan1, H. Mulcahy1, G. Doherty1
1St. Vincent's University Hospital, Centre for Colorectal Diseases, Dublin, Ireland
Background: Endoscopic dilatation of Crohn's disease (CD)-related anastomotic strictures is an alternative to surgical resection in selected patients. We aimed to evaluate the outcomes following endoscopic balloon dilatation of symptomatic anastomotic strictures in a single centre cohort.
Methods: A retrospective study of CD patients who underwent balloon dilatation identified from a prospectively maintained database of 2,700 Inflammatory Bowel Disease (IBD) patients attending a single academic centre was performed. Endoscopic balloon dilatation was performed with a controlled radial expansion (CRE) balloon (typically 15–18 mm) under endoscopic vision or fluoroscopic assistance.
Results: 53 procedures were performed on 31 patients (F = 14, M = 17). Primary surgical procedures were; right hemicolectomy/ileocaecal resection (n = 19), colectomy with ileorectal anastomosis (n = 6), sigmoid colectomy (n = 1), resection of previous anastomotic stricture (n = 4) and peristomal stricture (n = 1). Median time from initial surgery with anastomosis to stricture dilatation was 9 years (range 2–29). 3/31 patients failed initial dilatation and required surgery before 30 days. 28/31 (90%) patients had successful initial dilatation and no complications occurred. Of the 28 successful dilatations, 6 (21%) avoided further dilatations or surgery in the follow-up period; median duration was 16 months (range 8–24 months). Stricture recurrence was detected in n = 20 patients, of which 8 (28%) required multiple dilatations of the stricture only (median dilatations = 2) and 14 (50%) eventually needed surgery with a median time from initial dilatation to surgery of 14.5 months (range 2–142 months). There was no difference in immunomodulator (IMD) use, biologics use and smoking status between the groups requiring surgery versus non surgical management.
Conclusions: Endoscopic balloon dilatation of anastomotic strictures is safe. 50% of patients show a sustained response to single/serial balloon dilatation with avoidance of further surgical resection for a median interval of 2 years. Neither medical therapy afterwards with IMD/biologic agents nor smoking status predicts recurrent dilatation or surgery.