P0929Endoscopic stricturotomy: can break as a novel solution for Crohn’ s-related anal stenosis

Abstract Background Given the limitations of endoscopic balloon dilation and surgical therapies for CD-associated anal stenosis, this study assessed endoscopic stricturotomy (ES) as a potential treatment. Our objectives were to evaluate its safety and efficacy and to identify predictors requiring repeated intervention. Methods A retrospective study was conducted on 45 patients with CD-related anal stenosis who underwent ES at the IBD Center of Sir Run Run Shaw Hospital between January 2016 and May 2025. Demographic and clinical data, as well as stricture characteristics (type, length, and diameter), were collected. Short- and long-term treatment outcomes, recurrence, and complications were analyzed. Results A total of 66 ES sessions were performed in 45 patients, averaging 1.47 procedures per patient. Among them, 26 (57.8%) patients had tubular strictures and 19 (42.2%) had membranous strictures (Table 1). The mean stricture length was 1.8 (2, 4) cm, and the inner diameter was 5.07 ± 1.85 mm (Table 1). The baseline SES-CD score averaged 4 (0, 9), and the mean interval from disease onset to anal stenosis was 6 (4, 10) years (Table 1). After incision, all patients achieved a post-procedural inner radius greater than 1 cm, allowing smooth passage of the gastroscope. A single ES session was sufficient in 80% of patients, while 20% required two or more sessions (Figure 1). During a mean follow-up of 24 (13, 43) months, the non-intervention remission time reached 20 (11, 35) months, indicating sustained symptom relief in most patients (Table 2). Adverse events were rare, with bleeding, perforation, and infection each occurring in 1/66 (1.5%) procedures, and bleomycin was applied in 4/66 (6.1%) sessions (Table 2). Further analysis demonstrated that the baseline SES-CD score of rectosigmoid colon and stricture length were significant predictors of repeated endoscopic treatment, with an area under the ROC curve (AUC) of 0.8627 and 0.7792 (Figure 1). Conclusion Endoscopic stricturotomy (ES) is a safe, minimally invasive, and effective method for managing CD-associated anal stenosis. Higher disease activity and longer stricture may serve as predictors for repeated endoscopic treatment. Conflict of interest: Ye, Lingna: No conflict of interest Ms. Tian, Chuwen: No conflict of interest Fan, Rongrong: No conflict of interest Cao, Qian: No conflict of interest