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P580 Prognostic factors, effectiveness and safety of endoscopic balloon dilatation for de novo and anastomotic strictures in Crohn's disease – a multicenter “real life” study

Balint A.*1, Torocsik D.1, Palatka K.2, Szepes Z.1, Szucs M.3, Ferenci T.4, Nagy F.1, Farkas K.1, Fábián A.1, Bor R.1, Milassin A.1, Rutka M.1, Molnar T.1

1University of Szeged, First Department of Medicine, Szeged, Hungary 2University of Debrecen, Department of Internal Medicine II, Debrecen, Hungary 3University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary 4Óbuda University, John von Neumann Faculty of Informatics, Budapest, Hungary

Background

Crohn's disease (CD) is a chronic inflammatory disease which is frequently complicated by obstructive symptoms secondary to development of intestinal strictures. The aim of this “real life” study was to assess the effectiveness, safety and outcome of endoscopic balloon dilatation (EBD) in de novo vs. anastomotic stenoses.

Methods

Data of 144 endoscopic balloon dilatations in 63 CD patients were retrospectively analyzed. Technical success rate was defined as the ability of endoscope to traverse the stenosis after dilatation. Long-term clinical success rate was claimed if a patient remained asymptomatic and did not require surgery or further endoscopic dilatation following the technical success.

Results

63.2% of strictures were de novo and 36.8% anastomotic. The elapsed time between diagnosis and the first balloon dilatation was 9.5 (0–35) years. 78.5% of dilatations were successful over a short-term period without serious complications. 44.4% of patients showed that endoscopic balloon dilatation is effective over a long-term period. Long-term success rate was 29.2% in the de novo group and 68.2% in the anastomotic group (p=0.02); moreover, less patients needed surgery in the anastomotic group (de novo group: 20.8% vs. anastomotic group: 9.1%; p=0.07). Biological therapy before or after dilatation, immunomodulatory therapy and the time between the diagnosis and the first dilatation had no influence on long-term effectiveness. Thirteen subjects required surgery due to strictures after balloon dilatation.

Conclusion

The results of this study highlight that endoscopic balloon dilatation is an effective therapy of short strictures in CD with low complication rate. Using this endoscopic method we can avoid surgical interventions in most of the cases. EBD of anastomotic strictures showed better outcome than that of de novo strictures.