P0873Short and long-term outcomes of endoscopic balloon dilatation for Naïve and Anastomotic Crohn’s disease related strictures: A Canadian Tertiary Centre Experience

Abstract Background Over half of patients with Crohn’s disease (CD) develop intestinal strictures and requiring surgery.1 Endoscopic balloon dilatation (EBD) can be potential therapy for accessible and short (5cm) strictures, offering a less invasive option. Methods This retrospective cohort study included adult patients with CD aged ≥18 years who underwent EBD of intestinal strictures between Jan 2016 and Sep 2024 at two hospitals in London, Ontario, Canada. The primary outcome was technical success, defined by ability to pass the endoscope through the stricture after dilation without immediate complications. Secondary outcomes were clinical success at 6 and 12 months (m), subsequent hospitalization due to obstruction, and CD related surgery. We used Cox proportional hazards models to assess predictors of hospitalization and surgery. Results A total of 234 patients (age: 47.6 ± 15.2 yrs, males: 47.4%) were included with median disease duration of 17.7 years, median follow-up of 61 months. Over half of patients (53.9%) had a history of prior bowel resection and 66.2% were on advanced therapies at baseline. Baseline symptoms (abdominal pain and/or dietary avoidance) were present in 79.4%. Majority of the strictures were accessible to ileocolonoscopy (deep enteroscopy needed in eight patients). Most strictures were de novo type (62.5%) (most common in terminal ileum) and 37.5% were anastomotic type with ileocolonic anastomosis being most common, with 1 noted in 16.2% of patients. In 32.5% of patients, the strictures were considered purely fibrotic in nature on endoscopy, whilst 58.1% had ulcers at the site of stricture. Only in 9.4% of cases, the scope could be passed across stricture prior to EBD. Technical success was achieved in 81% and dilatation of at least 13.5mm could be achieved in 77.8%. Clinical success was noted in 47.7% at 6m and sustained at 12m. The cumulative probability of hospitalization due intestinal obstruction was 3.1%, 9.7%, and 15% at 1, 3 and 5 years respectively, whereas the cumulative probability of CD related surgery was 8.9%, 18.3% and 21.9% at 1, 3 and 5 years respectively (Figure 1). Presence of multiple strictures on endoscopy was associated with increased risk of surgery while anastomotic strictures and maximum balloon diameter were associated with lower risk of surgery. No patients experienced procedure related complications. Conclusion EBD was safe and effective with the majority of patients achieving technical success. De novo CD strictures demonstrated worse outcomes compared to anastomotic strictures, with presence of multiple strictures associated with a higher risk of surgery. Overall, our results provide valuable insights into the long-term outcomes following EBD Reference: Rieder F, Fiocchi C, Rogler G. Mechanisms, Management, and Treatment of Fibrosis in Patients With Inflammatory Bowel Diseases. Gastroenterology. 2017 Feb;152(2):340-350.e6. doi: 10.1053/j.gastro.2016.09.047. Epub 2016 Oct 5. PMID: 27720839; PMCID: PMC5209279. Conflict of interest: Dr. Vuyyuru, Sudheer: Received consulting fee from Alimentiv Inc Nigam, Gaurav: has received education support from Takaeda and speaker fees from Falk pharma Goodwin, Shane: None Sethi, Shivya: None Gregor, James: received speakers fees from AbbVie, Janssen, Takeda, Celltrion, Organon and Ferring Yan, Brian: None Sey, Michael: has received consultant fees from Medtronic research grants and speaker fees from Pendopharm educational grant from Cook Medical. Jairath, Vipul: Consulting Fees: Abbvie, Alimentiv, Amgen, Anaptys Bio, Asahi Kasei, Asieris, Astra Zeneca, Attovia, Blackbird Labs, BMS, Boehringer Ingleheim, Biomebank, Caldera, Calluna, Catalytic Health, Celltrion, Ensho, Enthera, Exeliome Biosciences, Ferring, Fresenius Kabi, Gilead, Granite Bio, GSK, Janssen, Lilly, Merck, Mountainfield, MRM Health, Nxera, Organon, OSE Immunotherapeutics, Pendopharm, Pioneering Medicine, Pfizer, Prometheus, Roche/Genentech, Sanofi, SCOPE, Shattuck Labs, Sorriso, Spyre, Synedgen, Takeda, Teva, Tillotts, Union Therapeutics, Ventus, Ventyx, Vividion, Xencor, Zealand Pharma.