P658 Long-term outcome of endoscopic balloon dilation for ileocolonic Crohn’s strictures
T. Taida*, T. Nakagawa, S. Hamanaka, H. Koseki, T. Sakurai, K. Okimoto, K. Saito, D. Maruoka, T. Matsumura, M. Arai, T. Katsuno, O. Yokosuka
Chiba University, Department of Gastroenterology and Nephrology, Chiba, Japan
Endoscopic balloon dilation (EBD) is an alternative to surgery for ileocolonic strictures of patients with Crohn’s disease (CD). EBD is important to avoid frequent operation due to recurrent strictures. However, little is known about the long-term efficacy of EBD. The aim of the present study was to clarify the efficacy and safety of EBD for ileocolonic strictures in patients with CD.
Included were 26 patients with CD who underwent EBD for ileocolonic strictures from August 2008 to November 2015 and were followed-up after dilatation. Indications for EBD were as follows: small bowel strictures causing obstructive symptoms; stricture length ≤ 5 cm; no associated fistula or abscess; no deep ulcer; and no severe curvature of the stricture. EBD was carried out mainly using a DBE (EN-450 T5; Fujifilm Medical Co., Tokyo, Japan) and an 8–18-mm through-the-scope (TTS) balloon catheter (CRETM balloon catheter; Boston Scientific Co, Natick, Massachusetts, Untied States). The balloon was inflated to a pressure of 1–7 atm, with the pressure being maintained for 1 minute. During the procedure, we usually use carbon dioxide insufflation to avoid retention of a large amount of air. EBD was carried out under conscious sedation produced by midazolam. All subjects had obstructive symptoms because of the strictures. Short-term success was defined by the disappearance of obstructive symptoms (eg, abdominal pain, bloating, and vomiting) after technically adequate dilation. The short-term success rate of EBD, its safety profile, the cumulative surgery-free rate, and the cumulative re-dilation-free rate were analysed.
EBD was performed 65 times for CD patients in the follow-up period. Short-term success rate was 100% (26/26), and no complications were encountered in this study. Two patients (7.7%) underwent surgery during the observation period of this study. Cumulative surgery-free rate after initial EBD was 90.3% at both 2 and 3 years. The cumulative re-dilation-free rate after initial EBD was 52.1% at 2 years and 39.1% at 3 years.
EBD for ileocolonic strictures secondary to CD provides not only short-term success but also long-term efficacy. However, the high re-dilation rate is 1 of the clinical problems of this procedure.