Interventional Endoscopy

51 - Multiple Primary Crohn’s Disease-Associated Strictures Had Poor Response to Endoscopic Balloon Dilation

Tuesday, October 9
3:05 PM - 3:15 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: Interventional Endoscopy
Nan Lan, MD1, Bo Shen, MD2
1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Digestive Disease Institute, Cleveland, OH

Introduction: Endoscopic balloon dilation (EBD) has emerged as an alternative to surgery in the treatment of Crohn’s disease (CD) strictures. We hypothesize that patients with multiple primary CD strictures had a poor response to EBD. The aim of this study was to compare the outcome of EBD in patients with single vs. multiple strictures.

Methods: All eligible patients with primary stricturing ileocolic CD (B2, L1 or L3) initially treated with  EBD from 2000 and 2016 were extracted. Patients were divided into two groups by diagnosis of single or multiple strictures. Multiple strictures were defined as >1 strictures dilated during single endoscopy session. The primary outcome was surgery-free survival and secondary outcome was post-procedural adverse events.

Results: A total of 117 CD patients were included in this study among whom 36 patients were dilated with multiple strictures and 81 with a single stricture. Patients with multiple strictures tended to have shorter and more transversable strictures. Consequently, immediate technical success was achieved at a higher rate in patients with multiple strictures. However, these patients required multiple dilations and had a shorter interval between treatment sessions. Post-dilation perforation was only seen in patients with multiple strictures and post-dilation nausea and vomiting were also seen at a higher rate in patients with multiple strictures.  Subsequent surgery rate was also significantly higher in patients with multiple strictures (66.7% vs. 35.8%, p<0.002). In multivariable analysis, decreased number of EBD sessions (hazard ratio [HR]: 0.6, 95% confidence interval [CI]: 0.5-0.7, p<0.001) and shorter interval of EBD sessions (HR: 0.2, 95% CI: 0.1-0.3, p<0.001) were protective factors for surgery-free survival. Multiple strictures treated were not independently associated with surgery-free survival (HR: 1.6, 95% CI: 0.9-2.8). A subgroup analysis was conducted. Patients treated with more than 3 strictures were associated with a significantly higher risk for subsequent surgery (HR: 14.1, 95%CI: 1.6-120.3) while patients with 2-3 strictures treated were not (HR: 1.5, 95% CI: 0.8-2.8).

Discussion: Multiple strictures treated with EBD were often shorter and transversable strictures. Although these patients can achieve technical success, the strictures often required frequent re-dilations with a higher perforation rate and subsequent surgery rate. Dilation of more than 3 strictures was associated with a lower surgery-free survival.

Table 1. Demographic and clinical presentation in primary Crohn’s disease patients treated with endoscopic balloon dilation.
Table 2. Multivariable analysis of factors associated with surgery-free survival.
Figure. Kaplan-Meier surgery-free survival in patients dilated with single stricture, 2-3 strictures and >3 strictures.

Disclosures:
Nan Lan indicated no relevant financial relationships.
Bo Shen indicated no relevant financial relationships.

Nan Lan

Research Fellow, Department of Gastroenterology and Hepatology
Digestive Disease Institute, Cleveland Clinic Foundation
Cleveland, Ohio

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