P614 Endoscopic Electroincision Therapy for Children

Abstract

Abstract Background Anastomotic strictures can be successfully treated by endoscopic balloon dilation (EBD); however, the emerging modality of stricturotomy with electroincision therapy (EIT) and strictureplasty(stricturotomy followed by endoscopic clipping) may achieve superior outcomes. Endoscopic stricturotomy has been shown to have greater efficacy than EBD in adult patients with IBD. While the rate of perforation is lower in EIT as compared to EBD in IBD, stricturotomy has a 4-10% rate of delayed bleeding, with a smaller proportion requiring blood transfusion. EIT can delay the need for surgical intervention and in many circumstances obviate the need indefinitely. This study is to describe the use of EIT for luminal strictures in children. Methods Retrospective cohort study of 10 pediatric patients (including 18 procedures) with anastomotic and primary luminal stricture who underwent endoscopic EIT with stricturotomy or strictureplasty. Outcomes and complications were documented. Results Among 18 performed, 14 stricturotomy and 4 strictureplasty, 2 patients did not require further intervention and had no stricture recurrence at time of follow-up. 3 patients required repeat stricture therapy but the time duration between interventions, previously EBD, extended. There were 2 procedural complications, tension pneumoperitoneum managed by needle decompression and microperforation, neither of which required surgical repair or resection. There were no episodes of GI bleeding. Conclusion EIT for luminal stricture in children may offer an alternative to EBD or surgical resection and re-anastomosis. The relative risk in children remains to be delineated.