P518 Five year outcomes of Crohn's small bowel strictures treated with double balloon enteroscopic dilatation.
N.S. Ding*, S. Mohammad, P. Hendy, A. Humphries, A. Hart
St Mark's Hospital, Inflammatory Bowel Disease Unit, London, United Kingdom
The management of Crohn's small bowel (SB) strictures remains a difficult problem. Options include medical management, endoscopic strategies and surgical procedures. St Mark's Hospital performs double balloon enteroscopy (DBE) and dilatation. We report the outcomes of this cohort of patients, in whom DBE dilatation was performed for SB strictures with follow-up period of at least 5 years, with the primary endpoint being avoidance of surgical resection.
All patients with CD, obstructive symptoms and documented SB strictures referred for endoscopic dilatation between January 2007 and February 2009 were included. A retrospective data analysis was performed, including case note review and structured patient interview. The following factors were evaluated: patient demographics; disease extent, location and severity; symptomatology; requirement for further DBEs; requirement for future surgery and complication rate.
A total number of 12 patients were identified with a mean age of 39 years (20- 59 years) and 65% were female. Prior to the procedure, all had been evaluated by cross-sectional imaging and/or endoscopy, with 9/12 undergoing imaging alone. 3/12 had prior resections for small bowel disease with one having short gut syndrome (approx. 70cm remaining). The follow up period was a median of 5.9 years (4.5-7.1).
A median of 2 (range 1-3) DBEs was performed per patient during the six year (median 5.5 - 8) follow up with 3/12 undergoing a single procedure, 8/12 undergoing 2 procedures and 1/12 undergoing 3 procedures. 7/12 patients had DBE via the rectal route with 5/12 per orally. Dilatation was performed in the ileum in 9/12 patients with the rest having duodenal (2/12) or jejunal (1/12) dilatation. 1 patient suffered a viscous perforation, diagnosed within 12 hours of the procedure, necessitating emergency laparotomy and resection with ileostomy. The remaining 11 patients did not suffer any post-procedure complications.
9/12 patients avoided surgical resection, and all 9 required multiple DBEs. The remaining 3/12 patients underwent a single DBE and subsequently required SB resection (1/12 suffered a perforation and 2/12 did not receive any symptomatic benefit from the dilatation). 5/12 patients gained a symptomatic improvement after dilatation.
The two patients who underwent 3 DBEs have felt well with weight gain and no recurrence of symptoms.
This analysis suggests that, for patients with CD, DBE dilatation of SB strictures can be effective at preventing progression to surgery, and that it may be a reasonable treatment option.