P562 Clinical outcomes of surgery versus endoscopic balloon dilatation for stricturing Crohn's disease
T. Greener*1, U. Kopylov1, R. Shapiro2, E. Klang3, N. Rozendorn3, R. Eliakim1, M.M. Amitai3, S. Ben-Horin1
1Chaim Sheba Medical Center, Gastroenterology, Tel Hashomer, Israel, 2Chaim Sheba Medical Center, Surgery B, Tel Hashomer , Israel, 3Chaim Sheba Medical Center, Radiology , Tel Hashomer, Israel
Endoscopic balloon dilatation (EBD) and surgery are commonly practiced in stricturing Crohn's disease (CD). Nonetheless, there are still scant data directly comparing these two strategies. The aim of this study was to compare the short and long term outcome of EBD versus surgical resection in symptomatic Crohn's strictures at one tertiary center.
This was a retrospective cohort study. The outcomes of all patients referred to EBD were compared to patients referred to surgery due to stricturing disease between the years 2006-2013. Patients undergoing surgery for non-CD stricturing disease were excluded.
Seventy nine patients were identified, 40 in the surgical group and 39 in the EBD group who underwent an overall of 72 dilatation procedures. The mean age was 42.81 ± 13.91 years and 38.52 ± 12.24 years in the EBD and the surgical group, respectively. Median duration of follow-up after the index procedure was 2.7 years (IQR, 3.7-1.2) and 3.5 years (IQR,5.6-1.2) for EBD and surgery, respectively (p=0.33). The patients' characteristics regarding disease location, perianal disease and immunosuppressive treatment during follow-up were similar. Disease duration was significantly longer in the endoscopically-treated patients (16.4 vs12 years; p=0.05). The stricture's location was not significantly different between the EBD and surgery group (Ileum: 68.2% versus 85.7%, p=0.51; Colon: 31.6 % versus 12%, p=0.1). The average stricture length was significantly shorter in the endoscopic dilated group compared to the strictures in the operated group (4.21 ± 2.13 cm versus 7.47 ± 4.84cm, p<0.05). Anastomotic strictures were more prevalent in the EBD group (30% versus 7.5%, p=0.01). The proportion of patients that required any re-intervention during follow-up was significantly lower in the surgical group in comparison to the EBD group (OR=5.62; 95% CI 1.66 19.01; p=0.005). The need for surgery/re-surgery during follow-up was also significantly lower in the surgically-treated group (OR 3.53; CI 1.01-12.29; p=0.047). Re-intervention-free survival and surgery-free survival were both significantly shorter in the endoscopically-treated group in a Kaplan-Mayer analysis. The major complication rate in the endoscpically and surgically-treated groups were similar and were 7.6% and 5%, respectively (p=0.7).
In our cohort of patients with fibrostenotic CD, a direct comparison shows that the long term outcome after surgery was more favorable compared with EBD.