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P428 Long-term outcomes of endoscopic ballon dilation for small-bowl strictures using double balloon enteroscopy in patients with Crohn’s disease

T. Takeda*1, F. Hirai1, N. Takatsu1, M. Kishi2, T. Beppu2, K. Yao3, T. Ueki2

1Fukuoka University Chikushi Hospital, IBD Center, Fukuoka, Japan, 2Fukuoka University Chikushi Hospital, Department of Gastroenterology, Fukuoka, Japan, 3Fukuoka University Chikushi Hospital, Department of Endoscopy, Fukuoka, Japan

Background

Crohn’s disease (CD) often progresses to stricturing or penetrating type. Although the most common reason for intestinal resection is gastrointestinal stricture, endoscopic balloon dilation (EBD) is a useful procedure for relieving stricture and thereby allowing avoidance of surgery. However, only a few studies have examined the long-term usefulness of EBD for treating small-bowel stricture. Our present CD patients who had undergone EBD for small-bowel stricture (including ileocolonic anastomotic stricture) were retrospectively examined to determine the long-term usefulness of this procedure.

Methods

The subjects had undergone dilation of small intestinal and ileocolonic anastomotic strictures by double balloon enteroscopy at our department between 2005 and August 2015. EBD was indicated for patients with stricture symptoms or confirmed stricture precluding passage of an endoscope whose stricture sites were free of deep ulceration, abscess or fistula, and measured less than 5 cm. The data on short- and long-term outcomes were collected from the records of patients meeting the indications. Short-term success was defined as the passage of an endoscope through the stricture site or a combination of technical success of EBD and resolution of stricture symptoms. For long-term outcomes, cumulative surgery-free rates were analysed.

Results

This study included 111 patients who had met the indications and undergone EBD. The patient characteristics were a male-to-female ratio of 88:23, mean age of 35.6 years, and mean symptom duration of 12 years. The disease types were ileal in 57 patients and ileocolonic in 54. The short-term success rate was 72.1% (80/111). Overall, the cumulative surgery-free rates were 63.8% at 4 years and 52.8% at 8 years. Surgery was necessary for small-bowel stricture in 74.5% of the patients and for other reasons (eg, fistula formation) in 25.5%. When the cumulative surgery-free rates were compared between patients with and without short-term success, the rates were statistically significantly higher in those with success (p < 0.05).

Conclusion

In CD patients, EBD for small-bowel stricture achieved a high short-term success rate and was useful for long-term avoidance of surgery after such success.