P331 Endoscopic Balloon Dilation Delays the Need for Subsequent Surgery in Patients With Strictures In Crohn's Disease Even In Ileocolonic Anastomotic (ICA) Localization ?
S. Hulagu, O. Senturk, G. Sirin*, A. Celebi
Kocaeli University, Gastroenterology, Kocaeli, Turkey
There are relatively published data comparing endoscopy and surgery in treating CD-related ICA in the literature. The aim was to compare the long-term outcome between endoscopic dilation and surgery for ICA stricture.
Eligible patients with ICA stricture treated with either endoscopic dilation vs. surgery between December 1998 and May 2013 were evaluated. Patients were divided based on the initial treatment at the inception point (endoscopic balloon dilation vs. restorative surgical resection). Patients with concurrent enterocutaneous fistula or abdominal abscess were excluded.
We included 96 patients (dilation, n=46 and surgery, n=40). The total number of dilations was 125 with a median of 2(1-7) per patient in the endoscopy group. There was no difference in the need for the subsequent surgery between the two groups (p>0.05). However, patients in the surgery group had a longer time interval from the inception to the subsequent surgery than those in the endoscopy group. Eight patients in the surgery group even underwent subsequent dilation for recurrent stricture. In univariate analysis, the need for subsequent surgery was associated with current smokers,corticosteroids or anti-TNF use. Kaplan- Meier analysis showed that the average time to surgery delayed by dilation was 4.25 years in the endoscopy group. In a subgroup analysis of the endoscopy group, patients with bowel dilation proximal to ICA stricture had a higher rate of need for surgery than those without.
Endoscopic dilation is an effective approach for ICA stricture in CD patients. The long-term need for subsequent surgery appeared to be comparable between the two groups, although the interval to the subsequent surgery in the surgery group was longer. Endoscopy dilation of ICA stricture is shown to space out the need for the second surgery and may be attempted first when feasible.