821 Presence of Obstructive Symptoms and Absence of Perianal Crohn’s Disease Is Predictive of Surgery After Endoscopic Balloon Dilation

Abstract

INTRODUCTION: Patients with Crohn’s disease (CD) often develop strictures that require surgery. Endoscopic balloon dilation (EBD) is an alternative treatment which can be safe and effective. The objective of this study was to assess factors associated with need for repeat EBD and surgery after initial EBD for stricturing CD. METHODS: Patients with stricturing CD who underwent EBD from 2007-2017 were identified. Demographic and clinical information was obtained from a review of electronic medical records. Outcomes of interest included adverse events, repeat EBD, and surgery. Cox proportional hazards regression model and Kaplan Meier curves were generated for variables associated with repeat EBD and surgical resection. RESULTS: 99 patients underwent a total of 240 EBD; 63% were women, 75% were Caucasian, and 20% were active smokers. 54% had ileocolonic disease, 35% had a history of perianal disease, and 63% were on a biologic at time of initial EBD. 51% of patients had obstructive symptoms at the time of initial EBD. The stricture location varied but anastomotic (52%) and ileal were most common (17%). 48% of strictures had an inflammatory component. 75% of EBD were successful. Complications occurred in 13 EBD (5%) and included abdominal pain (n = 5), bleeding (n = 3) and perforation (n = 2). 51 patients underwent repeat EBD. Repeat intervention after EBD was more likely in patients on biologics at baseline EBD (76% vs. 54%, P = 0.029). 33% of patients had surgical resection a median of 5 months (IQR 2.0-13.0) after initial EBD. The presence of obstructive symptoms at time of EBD was associated with surgical resection [HR = 3.18, 95% CI 1.28-7.86] (Figure 1). Conversely, a history of perianal disease was negatively associated with surgical resection [HR = 0.27 95% CI 0.10-0.68] (Figure 2). CONCLUSION: EBD is an alternative to surgery with good short-term response rates. With experienced gastroenterologists, EBD is safe with perforation rates of < 1%. Patients on biologic treatment at the time of EBD are more likely to need an intervention in the future, either EBD or surgery. One third of patients are referred to surgery after initial EBD; patients with obstructive symptoms at time of initial EBD and those without a history of perianal involvement are more likely to undergo surgical intervention. Gastroenterologists can consider these factors when offering EBD or surgery for treatment of stricturing CD.