P732 Endoscopic Balloon Dilation Of Symptomatic Intestinal Crohn’s disease Strictures: Long-Term Data On Efficacy And Safety In A Cohort Of Patients Followed-up For 10 Years
D. Scimeca1, F. Mocciaro*1, R. Di Mitri1, M. Giunta2, S. Renna3, G. Teresi4, E. Conte1, A. Bonaccorso1, A. Casà3, M. Cottone5, A. Orlando3
1Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy, 2Gastroenterology Unit, Villa Sofia-Cervello Hospital, Palermo, Italy, 3IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy, 4Internal Medicine, Villa Sofia-Cervello Hospital, Palrmo, Italy, 5Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy
Crohn’s disease (CD) is a chronic disease frequently complicated by obstructive symptoms secondary to development of intestinal strictures. In the medium-short-term period endoscopic through-the-scope (TTS) balloon dilation offered a valid therapeutic alternative in those with intestinal symptomatic strictures. Data on long-term efficacy and safety are still lacking. We present data from a cohort of CD patients treated with balloon dilation and followed for up to 10 years.
In 2011 we published data on a cohort of CD patients with symptomatic naïve or post-operative intestinal strictures treated effectively with endoscopic TTS balloon dilation (1–2–3 years cumulative symptom-free rates of 76%, 55% and 46%). In this cohort last balloon dilation was performed in December 2008 and 4 out of 37 patients underwent surgery. We followed-up the remaining 33 patients to the present day. Data on obstructive symptoms relapse, hospitalisation, surgical recurrence and safety were collected.
We collected data on 28 out of 33 patients (5 patients were lost at the follow-up): 16 male (57%), 27/28 patients had a post-operative stricture. Twenty-three patients (82%) have suffered from a clinical relapse (obstructive symptoms) through the follow-up, while 5 (18%) were in clinical remission: 7 (25%) were treated with mesalamine/steroids as needed, 6 (21%) with immunosuppressants and 15 (54%) with biological therapies. Fifteen/23 symptomatic patients (65%) underwent a new balloon dilation: 1 dilation in 6 patients, 2 dilations in 4, and more than 2 dilations in the remaining 5 patients; no complications after the re-dilation were recorded. Eight/23 symptomatic patients (25%) did not undergo a new balloon dilation: 4 were treated conservatively (steroids) while 4 were operated-on due to severe intestinal obstruction not suitable for endoscopic dilation. In patients treated with a new dilation, 60% (9/15) avoided new surgery at the end of the follow-up (75.8 ± 38.9 months). Seventeen patients (61%) were hospitalised during the follow-up (in 10 patients hospitalisation was scheduled to perform surgical intervention rather than an obstructive flare). Final overall surgical rate was 36% (6 patients in those re-dilated and 4 in those not re-dilated) with 64% of patients ‘free from surgery’ with or without new endoscopic balloon dilations.
Data from this long-term study shows that balloon dilation is an effective and safe procedure to treat CD symptomatic strictures. After an initial effective balloon dilation the sustained clinical benefit through the follow-up was over 60% considering that in those with obstructive symptoms relapse balloon dilation can be safely repeated limiting the need for surgery to just 1/3 of the patients.