Mo1601 Can Multiple Endoscopic Ballon Dilation Delay the Need of Surgery in Symptomatic Crohn's Disease Strictures? a Pilot Study

Abstract

Can Multiple Endoscopic Ballon Dilation Delay the Need of Surgery in Symptomatic Crohn’s Disease Strictures? a Pilot Study Giuseppina De Caro*, Nicola De’ Angelis, Maria Clotilde Carra, Alessandro Fugazza, Elisabetta Manzali, Barbara Bizzarri, Gian Luigi De Angelis Unit of Gastroenterolgy and Operative Endoscopy, University of Parma, Parma, Italy, Paris, Italy Background: In the last years, endoscopic balloon dilation (EBD) has been increasingly used in the treatment of Crohn’s disease (CD)-related strictures. The present study aimed to evaluate shortand long-term results of the efficacy and safety of EBD in a cohort of consecutive patients presenting with symptomatic CD-related strictures. Materials and Methods: 27 CD patients (11 men; median age 36.5 years, range 11-65 y.) with 28 symptomatic strictures, naive or postoperative, with or whithout fistula, irrespective of their dimension (up to 12 cm) and location (1 upper gastrointestinal, 2 small intestine, 15 ileo-colonic, 10 colonic), underwent EBD. EBD was performed under unconscious sedation, by the same endoscopist with a progressive inflation of 18 mm balloon held for 90 seconds under endoscopic and radiological control. In combination with ongoing immunosopressant therapy, each patient was treated with prednisolone after EBD with a dosing scheme of 1.5 mg/kg of weight per day (maximum allowed dose 60 mg/day) for 2 weeks, followed by a 4 week tapering course. The technical success of the procedure was define as the passage of endoscope through the stricture reaching a diameter of approximately 15 mm. The shortterm clinical success was defined as 6 months symptom-free periode after EBD. The long-term clinical outcome was to avoid surgery. Results: The mean followup time was 45.2 months (range 6-100). No procedure-related complications were reported, with a techinical success rate of 100%. Surgery was avoided in 92.8% of the patients during the observation period. Only 2 patients failed to respond to the endoscopic treatment and underwent surgical stricture resection. Of the 25 patients who did not undergo surgery, 12 patients received 1 EBD, and 13 required further dilations over time. The EBD success rate after the first dilation was 82.1%. No difference was observed between the EBD success rate for naive (n 13) and post-operative (n 15) CD-related strictures. The presence of stricture-associated fistula and the location at the ileo-coecal valve resulted significant predictors of surgery (p 0.05). Conclusion: EBD appears to be a safe and effective procedure to treat CD-related strictures of any origin and dimension. EBD can prevent or delay the need of recurrent surgical interventions, which increse the risk of developing short bowel syndrome and drastically affect the patient’s quality of life.