Sa1895 ENDOSCOPIC STRICTUROTOMY VS SURGICAL RE-RESECTION IN THE TREATMENT OF ANASTOMOTIC STRICTURES IN CROHN’S DISEASE

Abstract

Crohn’s disease (CD) patients are prone to have surgical resection and postoperative stricture at the re-anastomotic site is common. These strictures were conventionally treatment with another surgery or endoscopic balloon dilation. The novel treatment of endoscopic stricturotomy (ESt) developed by our institute had shown success in multiple patients. The aims of this study were to compare the short-term and long-term outcome of patients with ileo-colonic anastomotic (ICA) stricture treated with ESt vs. ileo-colonic re-resection (ICRR). Patients with stricture that were treated with ESt and/or ICRR were extracted from patient medical charts from 2010 to 2016. The selection of treatment was based on the clinical discretion of the managing physician. The degree of the strictures was defined according to the degree of resistance when passing the scope by the endoscopist (1=mild resistance, 2=moderate resistance, 3=severe resistance or unable to pass). The short-term outcome referred to immediate technical success and post-procedural complications. Long-term outcome was evaluated by stricture-related emergency room (ER) visits, hospitalization, recurrence and surgery-free survival. A total of 29 patients with ESt and 151 patients with ICR were identified. Patients in both groups presented with similar demographic background (Table). Immediate technical success was achieved in all patients within both groups. Out of a total of 48 ESt and 151 ICRR given, procedure-related complications were found in 3/48 (6.2% per procedure) patients undergoing ESt and 46 (30.5%) patients undergoing ICRR. Due to the curative nature of ICRR, patency was achieved in all patients immediately after the procedure. In patients receiving ESt, patency of the bowel lumen was seen in 11/18 (61.1%) patients and endoscopic improvement in length/degrees was seen in 1/18 (5.6%) patients. During follow-up period of 1.1 (0.2-1.8) years and 2.1 (1.1-4.1) years in the ESt and ICRR groups, respectively, disease-related hospitalization and ER were more common in the ICRR group. Stricture recurrence was later seen in one (9.1%) out of 11 patients who achieved complete healing from ESt and 19/151 (12.5%) patients receiving ICRR (P=0.73). Stricture related subsequent surgery was needed in 3 (10.3%) patients receiving ESt while 16 (10.7%) patients in ICRR group (P=0.96). Kaplan-Meier analysis also showed no statistical difference regarding stricture-related surgery-free survival (P=0.52) and recurrent stricture-free survival (P=0.91). ESt is an effective and safe way of treating ICA stricture in CD patients. ESt achieved similar stricture-related surgery-free survival and recurrence stricture-free survival as ICRR while relatively sparing the patients from postoperative complications. ESt may be considered as the first-line therapy.TableDemographic and clinical information of Crohn’s disease (CD) patients with anastomotic stricture treated with endoscopic stricturotomy (ESt) and ileo-colonic re-resection (ICRR). *Significant comorbidities: congestive heart disease, coronary bypass surgery, chronic obstructive pulmonary disease, renal stone or renal insufficiency, non-GI cancer, stroke, and liver failure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)