3460 Endoscopic dilatation of crohn's strictures: longterm outcomes in 85 consecutive patients.

Abstract

Background: Endoscopic dilatation of Crohn's strictures is a minimally invasive technique that may avoid surgery and preserve intestinal length. Longterm outcomes after dilatation require clarification. Aims: To review all dilatations of Crohn's strictures performed at a centre with a specialist interest in colonoscopy. Methods: Case notes of all Crohn's patients who underwent endoscopic stricture dilatation between 1988-1999 were reviewed. Results: 89 patients were identified, with follow-up information available in 85 patients (45 female,166 dilatations). Median age at first dilatation was 42(23-74). 109(65%) were performed as day cases with conscious sedation and 4 (2%) under GA. Median dilatations per patient was 1 (1-8). Strictures were anastomotic (ileo-colonic 50, ileal 6, ileo-rectal 4, sigmoid 2, pouch-ileal 1) in 63 patients (133 dilatations) and denovo (ileal 7, ileo-caecal 2, transverse 1,left colon 9, rectum 3,) in 22 (33 dilatations), median stricture length 2.5cm (1-12.5). Maximum balloon size was recorded in 125, median 18mm (10-20). In 10 distal strictures a rigid dilator (median 16mm [12-18]) was used after endoscopic guidewire placement. Median follow up time was 29.1 months (0.23-190.2). 67 dilatations (40%) were followed by definite clinical improvement. 21 patients (25%) have had no further procedure since their first dilatation, median follow up 23.6 months (0.3-102). 35 (41%) patients had a further procedure within 6 months of first dilatation (surgery 19, dilatation 16). Of these, 13 were technical failures at dilatation. Multiple dilatations were performed in 31 patients (36%), median interval 21.3 weeks (0.1-537.6). 44 patients (52%) had surgery for the stricture during follow up. 7 complications were identified (4.1%). 4 patients (2.9%) with dilatations for anastomotic strictures had minor bleeding not requiring intervention. 3 patients (8.6%) with denovo strictures had complications: 2 left colonic perforations (1 temporary loop ileostomy formed, 1 managed conservatively); the other (ileal) had a minor bleed. There was no mortality related to dilatation. Conclusions: Endoscopic management achieves long-term benefit in approximately 50% of patients with accessible Crohn s strictures. Repeat dilatation may be necessary. Most dilatations can be performed in endoscopy with conscious sedation. Greater caution is required when dilating de novo strictures.