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P713 Long-term efficacy of endoscopic balloon dilatation using single-balloon enteroscopy in patients with Crohn’s disease

K. Takahashi*1, S. Bamba2, Y. Morita1, A. Nishida1, M. Sasaki2, T. Tsujikawa3, A. Andoh1

1Shiga University of Medical Science, Department of gastroenterology, Otsu, Japan, 2Shiga University of Medical Science, Division of Clinical Nutrition, Otsu, Japan, 3Shiga University of Medical Science, Department of Comprehensive Internal Medicine, Otsu, Japan

Background

Small bowel stenosis is the most frequent reason for surgery in the clinical course of Crohn’s disease (CD). Although there are some reports showing the efficacy of endoscopic balloon dilatation (EBD) for gastrointestinal stenotic lesions, the data confined to small bowel stenosis is limited. Therefore, we investigate the effectiveness of EBD on small bowel stenosis in CD using single-balloon enteroscopy.

Methods

Among 252 CD patients (921 examinations) who underwent single-balloon enteroscopy at our University Hospital from November 2005 to December 2017, we performed EBD for small bowel stenosis for 91 CD patients (276 EBD sessions). We investigated the long-term efficacy of EBD, EBD complications, and factors related to surgical intervention. During this study period, we were given the opportunity to use prototype single-balloon enteroscope with passive bending mechanism. We also assess the usefulness of passive bending mechanism when performing EBD in patients with CD.

Results

The average age at initial EBD was 37 years old. The cumulative surgery-free rate using Kaplan–Meier analysis was 79.7% after 3 years, 76.0% after 5 years and 73.0% after 10 years. Multi-variate analysis was performed on factors contributing to surgical intervention by Cox regression analysis. As a result, long stenosis (≥2 cm), unsuccessful EBD was the significant factors for surgery. Primary stenosis (de novo) and secondary stenosis (anastomotic) were not associated with surgery. As for complication, there were two cases of localised peritonitis and two perforation requiring surgery in 276 EBD sessions. Among patients who underwent EBD, 25 patients underwent EBD more than twice with both conventional SIF-Q260 and prototype scope with passive bending mechanism. The depth of insertion was significantly longer by using prototype single-balloon enteroscope with passive bending mechanism.

Conclusion

A relatively high cumulative surgery-free rate was obtained over a long period of time by EBD for small bowel stenosis using single-balloon enteroscopy in CD patients. Length of stenosis is the significant factor related to surgical avoidance. Prototype single-balloon enteroscope with passive bending mechanism is useful in EBD for small bowel strictures of CD.