P372 Efficacy and safety of endoscopic balloon dilatation in the Inflammatory Bowel Disease: Results of the ENEIDA database.
X. Andújar Murcia*1, C. Loras1, M. Socarras2, E. Rodriguez3, B. Sicilia4, E. Iglesias5, M.J. Casanova6, Y. Ber7, J. Martínez-González8, I. Rodríguez9, L. Bujanda10, D. Montfort11, X. Calvet12, J. Barrio13, M. Calaf14, J. Guardiola15, Y. Zabana16, F. Fernández-Bañares16, M. Esteve16
1Hospital Universitari Mutua de Terrassa, Endoscopy, Terrassa, Spain, 2Hospital Clínic de Barcelona, Gastroenterology, Barcelona, Spain, 3Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain, 4Complejo Asistencial Universitario de Burgos, Gastroenterology, Burgos, Spain, 5Hospital Universitario Reina Sofia, Gastroenterology, Córdoba, Spain, 6Hospital Universitario de la Princesa, Gastroenterology, Madrid, Spain, 7Hospital Clínico Universitario Lozano-Blesa, Gastroenterology, Zaragoza, Spain, 8Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain, 9Hospital Galdakao-Usansolo, Gastroenterology, Bilbao, Spain, 10Hospital Universitario Donostia, Gastroenterology, San Sebastian, Spain, 11Hospital Consorci Sanitari de Terrassa, Gastroenterology, Terrassa, Spain, 12Hospital Parc Taulí de Sabadell, Gastroenterology, Sabadell, Spain, 13Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain, 14Hospital Universitari Germans Trías i Pujol, Gastroenterology, Barcelona, Spain, 15Hospital Universitari de Bellvitge, Gastroenterology, Hospitalet del Llobregat, Spain, 16Hospital Universitari Mutua de Terrassa, Gastroenterology, Terrassa, Spain
Background: Endoscopic balloon dilation (EBD) is the endoscopic treatment of choice for short stenosis in Crohn’s diseases (CD). Several uncontrolled observational studies have shown that EBD in selected patients is a safe and an effective alternative to surgery. Previously published series have limitations due to the heterogeneity of technique and different endpoints which makes comparisons difficult, and generally with small series of patients.
Aim: To evaluate the efficacy and safety of EBD in clinical practice environment in Spanish hospitals adhered to the ENEIDA project.
Methods: We identified all the patients undergoing EBD from the ENEIDA database. Additional information not included in the database was requested to the participating centres (14 hospitals): patient’s clinical information; stenosis data; and information about the effectiveness and complications of the EBD. Technical success was defined when the endoscope got pass through the stricture after the procedure and therapeutic success when it was not necessary another endoscopic or surgical treatment after 1 year or until the end of the follow-up. A logistic regression analysis was performed to assess the factors associated with therapeutic success.
Results: A total of 306 dilations were performed in 154 patients (140 CD, 12 ulcerative colitis and 2 indeterminate colitis) with a mean of 1.98 dilation per patient. In 41% of the cases the strictures were in the anastomotic site. The therapeutic and technical success was achieved in 47.4% and 65.2% of the EBD respectively with a median follow-up of 24 months (1-88). In multivariate analysis, the length of stenosis ( ≤ 4 cm) with an OR of 3.38 (95% CI:1.38-8.26;p=0.008) and the technical success with an OR of 2.57 (95% CI:1.23-5.40;p=0.012) were associated with therapeutic success; whereas the balloon diameter ( ≤ 12 mm) with an OR of 0.4 (95% CI:0.16-0.93;p=0.034) and the need of anti-TNF therapy with an OR of 0.26 (95% CI:0.13-0.50;p<0.005) were inversely associated with therapeutic success. The rate of major complications was 5.4%.
Conclusions: In a clinical practice environment, the EBD has a similar efficacy and safety than has been reported in tertiary care centres. The length of the stenosis ( ≤ 4 cm), the technical success, the balloon diameter (>12 mm) and not needing anti-TNF for disease control were the only factors associated with the therapeutic success. Randomized prospective studies are required to set what other factors are related to the response to EBD.