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* = Presenting author

P411 Five year outcomes of Crohn's anastamotic strictures treated with balloon dilatation

N.S. Ding*1, W. Yip1, M. Hanna1, B. Saunders2, S. Thomas-Gibson2, A. Humphries2, A. Hart1

1St Mark's Hospital, Inflammatory Bowel Disease Unit, London, United Kingdom, 2St Mark's Hospital, Department of IBD, Colorectal Surgery and Wolfson Unit of Endoscopy, London, United Kingdom

Background

Clinically relevant stricture is usually defined as a luminal narrowing with pre-stenotic dilatation and obstructive symptoms. Ileal resection is a good treatment for symptomatic Crohn's related strictures, but disease recurrence after 15 years is more than 50%, with the need for a second resection. Long-term outcome of endoscopic balloon dilatation is unclear as most cohorts have a follow-up time of less than 3 years.

Methods

All endoscopic balloon dilatations performed in Crohn's disease (CD) patients treated at St Mark's Hospital, Wolfson Unit, between 2007 and 2009 were retrospectively reviewed with the aim of collecting long-term (>5 year) data. Pre-endoscopic imaging was obtained for all patients with information collected on length of stricture, signs of activity of Crohn's disease and upstream dilatation. Clinical data on symptoms before and after each dilatation were obtained. Endoscopic data including level of activity, size of balloon and therapeutic success was collected.

Multivariate analysis of factors predicting repeat dilatation

Underlying demographicsAge0.29
Duration of disease0.432
Cross-sectional imagingMucosal enhancement0.107
Upstream dilatation0.271
EndoscopyActive disease (i2-i4)0.006
Size of balloon diameter0.094

Results

A total of 37 patients were identified from hospital records with a median age of 46 years (39-55) with 16/37 (43%) male and a median follow-up period of 6.48 years (5.81-7.89). The median duration of disease was 24 years (17-30). From cross-sectional imaging (CT/MRI), length of stricture was described in 31/37 cases with a median of 20 mm (15-40) and features of active inflammation (mucosal enhancement) at anastomosis in 22/30 (73%) with upstream dilatation in 14/30 (48%). At the time of endoscopy, active disease was described in 24/27 (88.9%) of reports with a median balloon dilatation size of 15mmHg which achieved therapeutic success (passable) in 33/37 (89%). 6/37 (16%) have had surgical resection.

The median number of dilatations was 2 (range 1-6) with a median time to repeat dilatation of 23 months (7.2-56.9). 60% of patients required repeat dilatations. It was not necessary to perform repeat dilatations in 9/37 (24%) patients. Active disease at time of endoscopy was the only factor that predicted for repeat dilatations (p=0.006). (Table 1)

Conclusion

At long term follow-up, 16% of patients required surgical resection. 24% of patients were well with no further endoscopic intervention required. 60% required intercurrent endoscopic dilatations. This is the longest follow-up period in the literature and demonstrates that the effects can be durable and avoidance of surgery possible in a group of patients with anastamotic strictures.