P-144 Endoscopic Balloon Dilation of Ileo-Colonic Strictures in Children with IBD

Abstract

Anastomotic strictures are well known complication in patients with Inflammatory bowel disease (IBD). They have historically been treated either by surgeons or under fluoroscopic guidance. Both these procedures have certain complications like perforation and radiation exposure. Through the endoscope (TTS) balloon dilation of strictures is a well-defined modality of treatment for esophageal strictures in pediatric population. However, it has not been extensively defined for ileo-colonic strictures. There were no pediatric studies found on PubMed/Medline search. A 16 year old female was diagnosed with ulcerative colitis 3 years back and required colonic resection with ileo anal anastomosis and pouch creation. She presented 6 months after definitive surgery with complains of abdominal distention and subsequent decrease in stool output. Her radiological studies were consistent with stricture at the anastomosis site. She had surgical dilation of stricture under fluoroscopic guidance with poor outcome. In the Endoscopy suite she underwent balloon dilation of the stricture with an upper pediatric scope (a pediatric colonoscope could not be advanced through the stricture). Patient required 3 sessions of dilation 4 weeks apart and that led to resolution of symptoms. There was no complication with the procedure. Patient remains asymptomatic till date (1 year) post dilation. Colonic obstruction may occur due to a wide variety of causes. Acute obstruction may result from colonic volvulus, intussusception and hernia. Less acute presentations result from strictures or extrinsic compression of the bowel. Anastomotic strictures have been reported to occur in up to 30% of patients undergoing colorectal surgery (as per adult studies). TTS stricture dilation has been shown to be effective for the treatment of strictures resulting from both surgical anastomosis and IBD in adult populations. It is technically successful in 73 to 97% of patients, although the majority of patients experienced recurrence, requiring repeated balloon dilation or surgery. Major Complications include bowel perforation, severe bleeding, infection or recurrence. A local steroid injection in conjunction with TTS dilation has shown to reduce the need for repeated procedures or surgeries. Endoscopic guided balloon dilatation holds promise as an alternative to surgical treatment in children with strictures of large bowel, and should be considered in select patients with short strictures.