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P190. Endoscopic balloon dilatation of anastomotic strictures in patients with Crohn's disease: Effect of immediate endoscopic success and biological therapy

M. Bortlík, E. Bouzková, D. Ďuricová, V. Komárek, N. Machková, M. Lukáš

IBD Clinical and Research Center ISCARE and 1st Medical Faculty Charles University, Prague, Czech Republic

Aim: Patients with stenosing and/or perforating type of Crohn's disease are at high risk of restenosis at the site of ileocolonic anastomosis and neoterminal ileum. The study was aimed to assess the efficacy and safety of endoscopic balloon dilatations in patients with newly developed anastomotic strictures.

Material and Methods: All endoscopic balloon dilatations performed in CD patients treated in our centre between 2007 and 2010 were retrospectively reviewed. Patients with anastomotic stricture who were dilated either for obstructive symptoms, or for incidental finding of endoscopically significant stenosis were included. Clinical data on symptoms before and after each dilatation, medication and outcome of each dilatation were retrieved from patients' files. Independent-Sample T test was used for statistical analysis with p < 0.05 considered significant.

Results: We enrolled 54 patients (mean age 40.5±12.8 years), in whom 86 dilatations were performed with the median follow-up of 28 months (range 10–39). Immediate endoscopic success of dilatation expressed by possibility to pass the scope through the stricture was achieved in 62% of procedures. Off 68 dilatations performed for obstructive symptoms clinical efficacy was observed after 65 (96%) sessions with the median duration of symptom-free interval of 14 months (range 2–31). Duration of the clinical effect was not affected by immediate endoscopic success (median 13 months in passable vs. 14 months in not passable dilatations, p = 0.48). Interestingly, patients treated with infliximab or adalimumab had a significantly shorter duration of the symptom-free period compared to those without biologicals (median 11 vs. 16.5 months, p = 0.04). No major complication was observed.

Conclusions: Endoscopic balloon dilatation of the anastomotic Crohn's strictures is efficious and safe alternative to repeated surgical resections. Clinical effect after dilatations seems to be independent on immediate endoscopic success, whereas significantly shorter symptom-free interval was found in patiens on biological therapy.