1173 Patients Taking Proton Pump Inhibitors Are More Likely to Respond to Endoscopic Dilation of Benign Duodenal Stenosis, Regardless of the Etiology

Abstract

INTRODUCTION: Benign duodenal stenosis (BDS) is usually managed by endoscopic balloon dilation (EBD), but there is very limited literature on this practice outcomes. We sought to investigate the etiological spectrum, response to EBD and predictors for successful EBD. METHODS: We performed a cohort study of a prospectively maintained database of benign duodenal stenosis at a tertiary referral center between 2013 and 2018. Pyloric stenosis patients were excluded. All patients that underwent EBD were analyzed. Dilation was performed using through the scope balloons. Technical and clinical success of initial and repeat EBD were compared among the BDS etiologies, location within the duodenum, and number of stenotic tracts. Logistic regression models were performed using SAS software. RESULTS: A total of 276 patients were analyzed, of whom 87 patients underwent EBD for BDS. Most common etiology was peptic ulcer disease (PUD) 42 (45%) (Table 1). Upon initial EBD, technical success was 96.5% and clinical success was 74.4%. Upon repeat EBD, technical success was 98.1% and clinical success was 78.7%. When comparing PUD vs. All others, initial clinical success was 77.8% vs. 71.4% (P = 0.52), and on repeat EBD clinical success was 72.0% vs. 86.4% (P = 0.23). When comparing Crohn’s disease vs. All others, initial EBD clinical success was 72.2% vs. 75.0% (P = 0.81), and repeat EBD clinical success was 91.7% vs. 74.3% (P = 0.20). When comparing location of the stenosis in the 1st portion of the duodenum vs. distal duodenum, initial EBD clinical success was 70.0% vs. 82.1% (P = 0.24), and repeat EBD clinical success was 75.0% vs. 78.7% (P = 0.36). When comparing single vs. multiple strictures, initial EBD clinical success was 73.0% vs. 100.0% (P = 0.57), and repeat EBD clinical success was 77.3% vs. 100.0% (P = 0.99) (Table 2). 15 patients underwent planned/prophylactic EBD, but this did not impact the outcomes. Males were more likely to have distal duodenum stenosis when compared to females (63.6% vs. 36.4%, P = 0.007). African American had a lower likelihood of clinical success (aOR 0.083, P = 0.004), and usage of PPI increased likelihood of clinical success (aOR 3.65, P = 0.04) (Table 3). CONCLUSION: EBD has very high technical and clinical success rates in BDS. Males tend to have more distal duodenal involvement; African Americans ethnicity are less likely to respond to EBD and importantly, PPI usage was an independent predictor for EBD clinical success regardless of etiology.