O137 Strictureplasty for small bowel Crohn's disease in the biologic era: long-term outcomes and risk factors for recurrence

Abstract

Abstract Introduction Strictureplasty is a mainstay bowel-preserving technique for small bowel Crohn's disease (CD). We sought to audit international practice across three high volume centres. Methods A retrospective audit was performed for all strictureplasties undertaken for small bowel CD, over a 15-year period (2006-2021), in three high volume centres in the United Kingdom and Italy. Results 123 patients were included. 58% were male, 25% smoked, 60% had previous abdominal surgery for CD. Median age was 40 years (IQR 30-52 years), weight 64kg (56-72kg) and disease duration 138 months (81-255 months). 42% had biologics pre-operatively. 338 strictureplasties were performed in 123 patients, median 2 per patient (IQR 1-3). Complications occurred in 35%, with 8% being Clavien Dindo grade 3; there were no grade 4/5 complications. 84/123 patients (68.3%) received postoperative biological treatment. Median follow-up was 54 months. 41/123 patients (33.3%) developed clinical recurrence. Radiological recurrence of stricturing disease was confirmed in 39/123 (31%). 26/123 patients (21%) underwent re-operation for radiologically confirmed stricturing recurrence. Radiological recurrence rates were 53% in patients who continued to smoke after index surgery versus 30% in patients who did not (P=0.04). Radiological recurrence rates did not differ significantly in patients receiving postoperative biologics versus those who did not (33.3% vs 36.7%; P>0.05). Conclusion Strictureplasty remains safe and effective surgical treatment for small bowel CD. Recurrence rates remain high with patients likely to undergo multiple procedures in their lifetime, regardless of postoperative biologic therapy. Smoking cessation strongly limits the risk of recurrence.