DOP044 Efficacy, safety and long-term outcome of endoscopic dilation therapy for Crohn’s disease strictures of the upper gastrointestinal tract: an international multicentre cohort study including 99 patients with 129 dilation procedures

Abstract

Location of strictures in Crohn’s disease (CD) follows location of inflammation and may occur in all segments of the gastrointestinal (GI) tract. In contrast to ileocecal strictures, data on endoscopic balloon dilation (EBD) for CD-associated strictures of the upper gastrointestinal (UGI) tract is exceedingly rare. We therefore performed an international multicentre combined efficacy and safety study of EBD for UGI CD-associated strictures. Individual patient data were collected through electronic case report forms. Primary strictures of the stomach and duodenum up to the ligament of Treitz were included. Technical success (ability to dilate the stricture) and clinical success (symptom improvement) were recorded. Time-to-event analysis was performed to assess symptom recurrence, need for re-dilation or surgery. Kaplan-Meier estimates were used to calculate event rates. For multivariable Cox regression models, variables available for at least 85% of subjects were used and score method was chosen to build the best model with two factors for each outcome. A total of 99 CD patients and 129 performed dilation procedures were included. Stricture locations were duodenum n = 100, stomach n = 25; spanning stomach and duodenum n = 4 and 79.5% of strictures were shorter than 5 cm. Technical success rate was 98.4% resulting in clinical efficacy in 85.7% of patients. Major complications defined as perforation, bleeding or dilation-related surgery, occurred in 3.3% of all procedures. During a median follow-up period of 36 months, 71.4% of patients experienced symptomatic recurrence and 63.5% underwent re-dilation, while 31.6% of patients required surgical intervention. Factors associated with decreased clinical efficacy were active ileocecal disease and pre-stenotic dilation. On multivariable analysis, patients with mid small-bowel disease location (HR 2; p = 0.036) and 5-ASA at time of dilation (HR 2.7; p = 0.003) had a higher hazard for symptom recurrence. Asian race (HR 2; p = 0.042), mid small-bowel disease location (HR 1.9; p = 0.008) and use of 5-ASA (HR 2.1; p = 0.016) increased the need for re-dilation. Pre-stenotic dilation (HR 2.1; p = 0.002) and the use of 5-ASA (HR 4.3; p < 0.001) or anti-metabolites (HR 3.9; p < 0.001) were risk factors for earlier need for surgery. The to date largest multicentre evaluation of EBD for CD-associated strictures of the UGI tract revealed a high rate of short-term technical and clinical success with moderate long-term efficacy and acceptable complication rate. EBD should be considered an alternative to surgery in carefully selected patients.