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P647 Efficacy and safety of endoscopic balloon dilation for symptomatic intestinal Crohn’s disease strictures

A. Casadei, E. Cavargini, L. Samperi, D. Valpiani*, I. Manzi, E. Ricci

U.O. Gastroenterologia ed Endoscopia digestiva Ospedale ‘G.B. Morgagni’, Dipartimento di Medicina specialistica, Forlì, Italy

Background

Endoscopic balloon dilatation is a recognised treatment for symptomatic Crohn’s strictures. Several case series report its efficacy. The aim of our study were to evaluate prospectively the clinical efficacy and safety of endoscopic pneumatic balloon dilation (EBD).

Methods

Between January 2003 and September 2014, a cohort of 40 consecutive Crohn’s disease pts (range 30– 75 years) with symptomatic intestinal strictures was submitted to 136 EBD (range 1–7). In 25 pts strictures were ileo-colonic anastomotic, and in 15 were de novo (6 ileal, 4 ileocecal valve, 4 colonic, and 2 rectum). All pts were studied with ileocolonoscopy and CT/RM enterography. Strictures ≤ 5 cm were endoscopically treated, whereas longer strictures were referred for surgical treatment. Endoscopic dilatation was performed with CRE balloon, starting from a minimum calibre of 12 mm to a maximum of 20 mm. If the first attempt was deemed partial, a further dilation was performed in 2 weeks; if the second procedure turned out to be inadequate, the pt was referred for surgery (1 pt). In case of good outcome, pts were included in a follow-up programme with clinical examination; colonoscopy and subsequent endoscopic pneumatic dilation were performed only in case of new symptoms. Median follow-up was 32 months (range 3–72).

Results

The rate of technical success (crossed stenosis from the scope after dilatation) was 97.5% (all except 1 patient with angled ileal stenosis). The long-term clinical efficacy rate on follow-up (absence of obstructive symptoms after dilatation) occurred in 31 pts (79.5%). During follow-up, 15/27 pts (55%) needed further dilatation at 1 year; 15/23 pts (65%) at 2 years; and 12/16 pts (75%) at 3 years. Surgery was necessary in 8 patients (2 at 12 months; 2 at 24 months; and 4 at 36 months—3 ileal and 5 anastomotic location). Mayor complications included 1 pt with covered perforation (0.74% considering all 136 dilations) treated with medical therapy; 0% haemorrhagic.

Conclusion

Our data confirm a clinical efficacy comparable to the current literature, whereas in our series fewer complications have occurred. Endoscopic dilation of CD short strictures should be considered as first-line therapy by skilled endoscopist. Further, larger multicentre studies are still necessary to optimise and standardise this endoscopic therapy and to set follow-up.