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P192. Long-term outcome of endoscopic balloon dilatation in Crohn's stenosis is not associated to steroid intrastricture injection and to use of larger balloon

C. Cicerone1, I. Komazec Lukic2, M.G. Graziani2, 1Sapienza, Dip. Medicina Interna e Specialità Mediche, Rome, Italy, 2San Camillo Forlanini, Endoscopia Digestiva, Roma, Italy

Background

Endoscopic balloon dilatation (EBD) is the treatment of choice for intestinal short stricture in Crohn's disease (CD). The use of steroid intrastricture injection (SII) after balloon dilatation (BD) has been reported but the safety is controversial [1,2].

Aim: To investigate the short and long-term outcomes of EBD for CD strictures.

Methods

38 endoscopic BD were performed in 27 patients (pts) between 2006 and 2012 (14 women; 13 men; mean age 41 years). The inclusion criteria were symptomatic strictures refractory to medical treatment (20 thiopurine and 7 steroids therapy), with a length less than 5 cm (mean 2 cm); the exclusion criterion was the coexistence of a fistulizing pattern. All dilations were performed using through-the-scope balloons; in 24 procedures, was used, a balloon of diameter greater than 15 mm; in 14 a diameter less than 15 mm. The mean follow-up time was 18.8 months (5–50 months). Primary success was defined as passage of the scope through the stricture. Long-term outcomes were analyzed focusing on intervention-free survival.

Results

The 28 strictures (a pts had two de novo stenosis) included 10 anastomotic strictures (AS), 5 at the colocolic and 5 at the ileocolonic anastomosis, and 18 de novo strictures (DNS), 3 in the ileum, 4 in the sigma, 2 discendent colon, 6 in the rectum and 3 at the ileocaecal valve. Thirteen pts (46%) had active inflammation (AI) to biopsies and received a local quadrantic injection of triamcinolone (40 mg dose) after BD. Primary success was achieved in 37 of the 38 strictures (97%). Of the 38 treatments, complications occurred in 4 cases (10%) consistent with perforations. There was no procedure-related mortality. After a median follow-up of 12 months, re-strictures after EBDs occurred in 5 cases (22%). In conclusion at 1-year follow-up, 66% of the pts had undergone no further intervention (EBD or surgery) with a substantial but no significative difference in pts treated with SII compared to those treated only with EBD (8% vs 28% p = 0.163). No significant difference between the AS and DNS in the reintervention-free survival (RFS) at 1 year follow-up (80% vs 83% p = 0.825). In pts treated with the larger balloon the RFS was 70% versus 78.5% in pts treated with the smaller balloon (p = 0.803).

Conclusion

This study confirms that EBD may be an effective alternative to surgical resection. SII did not to prolong significantly the efficacy of BD in selected pts with AI. The use of a balloon greater than 15 mm is not associated with a better long term outcome.

1. A. Gustavsson et al., 2012.

2. East JE et al., 2007.