Evaluating the Predictors of Endoscopic Balloon Dilation Failure, Success and Surgery Prevention in Crohn's Disease-related Strictures

Abstract Background: Long-term outcomes after endoscopic balloon dilation (EBD) for managing fibro-stenotic strictures in patients with Crohns disease (CD) are poorly defined in the literature. Aims of this study are to evaluate the efficacy of EBD in delaying surgery for the treatment of CD-related strictures and identify clinical, endoscopic, and stricture-related factors associated with avoidance of surgery after five years of EBD. Methods: Retrospective cohort study including patients with CD undergoing EBD at a tertiary academic center from 01/2007-12/2021. Demographics, surgical and medication history, disease and stricture characteristics, need for surgical intervention, time to surgical intervention, and need for re-dilation were collected. Outcomes were followed from index dilation up to five years post-dilation. Results: 422 patients with CD (53.3% female, mean age 45) underwent EBD during the study period (813 total dilations). Location of the stricture was upper gastrointestinal in 24 patients (7%), and ileal (37.3%), colonic (13.2%), ileocolonic (47.8%) in others. 135 participants (32%) required surgery for CD-related stricture during the 5-year follow-up period. 181 patients (42.9%) required re-dilation. Prednisone therapy was a predictor for progression to surgery post-EBD (p=0.002). Patients with De Novo strictures were more likely to undergo surgery compared to those with anastomotic strictures (p=0.004). Eight patients (2%) had complications, with 3 of those requiring surgery. Conclusion: 68% of patients who underwent EBD avoided surgery. Steroid therapy was predictive of surgical resection within 5 years. Similar to existing literature, anastomotic strictures had better outcomes than De Novo.