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P493. Endoscopic balloon dilatation in patients with Crohn's disease (CD): Long-term outcome and patient satisfaction

A. Rueda Guzman1, A. Naumann2, N.P. Malek1, M. Goetz1, 1University Hospital Tübingen, 1Department of Gastroenterology, Hepatology, and Infectiology, Medical Clinic, Tübingen, Germany, 2University Tübingen, Institute for Clinical Epidemiology and Applied Biometry, Tübingen, Germany

Background

Stricture formation is a common complication of CD. We retrospectively analysed long-term outcome, safety and patient satisfaction of endoscopic balloon dilatation of CD-associated strictures performed at the University Hospital Tübingen, Germany.

Methods

Patients were identified from our database and were contacted by questionnaire or telephone. Technical success was defined by passage of the endoscope after dilatation.

Results

Between Jan. 2005 and Jan. 2013, 46 patients with 69 strictures underwent 118 balloon dilatations (Table 1). 10 patients had more than one (2 to 8) stricture. 90% of the interventions (95/106) were technically successful. In 12 cases, an attempt to pass the stricture was not recorded. During a median follow-up of 4.8 years (range 0.4–8.7), 56% (25/45 patients) were able to avoid surgery. 36% (16/45) did not need any further intervention. 11/45 patients underwent surgery after the first dilatation due to failure of short term relief (6), fistula (2), stricture length (1), technical failure (1) or perforation (1). Perforation occurred in 2/118 dilatations (1.7%), 1 requiring surgical intervention. In retrospect, 78% of patients were satisfied with the procedure. Surgery-free and intervention-free survivals were 59.1 months (median) and 18.3 months (median), resp. (Kaplan–Meier analysis, Figure 2). Performing Fisher's exact test endoscopic inflammation (p=0.024) and drug therapy (p=0.027) were significantly correlated with need for surgery.

Figure 1.

Figure 2.

Table 1. Patient characteristics - 46 patients, 69 strictures
Number of dilatations118
% female / % male41/59
Mean age (+SD)48 (+11.6) years
Median follow-up (min–max)4.8 (0.42–8.67) years
% anastomotic38
% smokers36
Mean disease duration (min–max)216 (1–419) months
% inflammation
 active75 (52/69)
 not active16 (11/69)
 no record9 (6/69)

Conclusion

Endoscopic balloon dilatation provided long term relief in 50% of patients up to 5 years with a low complication rate and a high acceptance by patients. Inflammation at the stricture was a risk factor for recurrent intervention. Our data confirms that endoscopic dilatation can be offered as a safe and effective first line therapy in CD associated strictures.