P292. Endoscopic dilatation of ileocolonic Crohn's (CD) strictures
S. Maltoni1, I. Manzi1, D. Valpiani2, E. Cavargini1, A. Casadei1, E. Ricci3
1Ospedale Morgagni, Forli, Italy; 2Ospedale Morgagni, Divisione di Gastroenterologia ed Endoscopia Digestiva, Forli, Italy; 3Ospedale Morgagni, Direttore U.O. di Gastroenterologia ed Endoscopia Digestiva, Forli, Italy
Background: Intestinal strictures are a frequent complication of CD. The present study assess clinical success rate, long term outcome and safety of endoscopical dilatation.
Methods: Between Jan 2003 and Sep 2011 we treated 27 following patients (17 m and 10 f, age range 3365 years; treated stenosis were 34, 17 had previously underwent intestinal resection; follow up 393 months). Strictures were located in the ileum (7), ileo-cecal valve (4), ileocolonic anastomosis (17) and in the colon (6).
Our patients underwent from 1 to 26 dilations (media 4.5; total dilations 122).
Before, all patients were studied with colonoscopy and CT/RM enterography; for strictures < than 8 cm was performed endoscopic treatment whereas longer strictures were referred for surgical treatment. Endoscopic dilatation was performed with CRE balloon, starting from a minimum calibre of 12 mm to a maximum of 20 mm. If the first attempt was deemed partial, a further dilation was performed in 24 weeks. During the same procedure in 15 patients were dilated more than one stricture for a maximum of 3. In case of good outcome the patients were included in a follow-up program with periodical clinical examination; colonoscopy and potential endoscopic pneumatic dilatation were performed only in case of new onset of symptoms. Patients who failed relief of symptoms after dilatation or developed a more extended stricture, were referred to surgery.
Results: Clinical success rate, defined as symptoms relief after one dilatation, was 92.6% (25/27).
At the end of follow up period, 4 (15%) patients were referred to surgery; 3 for the persistence of symptoms (respectively 1 patient after 2 months, 1 after five months and one patient after 15 months from the last dilatation for clinical relapse). One patient was referred to surgery for onset of abdominal abscess.
We didn't report any major complication; 26% of our patients (7/27) presented abdominal pain after procedure, treated with medical therapy.
Conclusions: Endoscopic dilatation should be considered as a first-line therapy for Crohn's patients with short intestinal strictures in attempt to delay surgical intervention. It is a safe and effective procedure. Further randomized multicenter studies should be required in order to plan a better management of these patients.