Re-intervention rates and symptom-free survival at 1year after endoscopic versus surgical management of strictures in Crohn's disease: A propensity matched analysis of a prospective inflammatory bowel disease cohort.

Abstract

Resection for Crohn's disease (CD) related strictures is definitive but carries risk of morbidity, recurrence, and short bowel syndrome. On the contrary, the durability of endotherapy (ET) for CD-related strictures is questionable. Prospective comparative studies are limited. We aimed to prospectively compare the outcomes of ET in CD strictures with a case-matched surgical therapy (ST) cohort. Patients undergoing ET or resection for primary CD strictures (symptomatic, non-traversable, <5cm length, n≤3) between January 2021 and March 2022 in a high-volume tertiary center were compared with regard to recurrent symptoms, escalation of therapy, re-intervention, and re-operation based on propensity matched analysis. Fifty-nine patients [49% ET, 57.6% male, median (years): 34 (15-74)] had ≥12months of follow up. Before propensity matching, cumulative re-intervention rate was significantly higher with ET [34.5% (10/29) vs 3.3% (1/30) ST, P=0.002]. Recurrent symptoms (34.5% vs 26.7%, P=0.42), escalation of medical therapy (27.5% vs 23.3%, P=0.64), and re-operation (7.4% vs 3.1%, P=0.55) were comparable. In propensity matched analysis adjusted for demographics, disease, and stricture characteristics [n=42, 21 each, 62% male, median (years): 32 (15-60)], cumulative probability of re-intervention rates was higher in ET (28.6% vs 4.8%, P=0.042). The cumulative probability of recurrent symptoms (ET: 33.3% vs surgery 33.3%, P=0.93), therapy escalation (ET: 23.8% vs surgery 28.6%, P=0.75), and re-operation (ET: 9.5% vs surgery 4.8%, P=0.57) was similar. ET for CD strictures require higher re-interventions compared with resection although re-operation could be avoided in the majority with comparable symptom free survival at 1year.