P0528Pre-stenotic dilation size in small bowel Crohn’s disease strictures on intestinal ultrasound is a predictor of clinical outcomes

Abstract Background Small bowel Crohn’s disease (CD) stricture severity is evaluated by magnetic resonance enterography (MRE), computed tomography enterography (CTE) or intestinal ultrasound (IUS) with comparable accuracy (1). Strictures on cross-sectional imaging are characterized by bowel wall thickness, luminal narrowing, and pre-stenotic dilation (PSD). PSD size on MRE and CTE is associated with increased surgical risk (2-5). No recent studies have evaluated the impact of PSD diameter in small bowel CD strictures on IUS and long-term outcomes. We aimed to describe the proportion of patients with small bowel CD strictures on index IUS and subsequent CD-related hospitalization or surgery. Methods A retrospective chart review was conducted at a single tertiary centre to identify patients with small bowel Crohn’s disease strictures and PSD to determine the initial documentation of PSD via intestinal ultrasound (IUS). Patients were excluded if PSD was detected on MRE or CTE prior to the index IUS examination. Statistical analyses included unpaired t-tests with Welch’s correction for continuous variables and Fisher’s exact test for categorical variables. Results Seventy-nine CD patients with PSD were identified that met study inclusion with index IUS from 2014-2025. The median follow up was 4.8 years (range 1-17.5). In 57.0% (n = 45) patients, the stricture was naïve whilst 43.0% (n = 34) had anastomotic strictures. Mean CD duration at PSD detection was 12 years (0-55). Median bowel wall thickness (BWT) was 7.0 mm (3-12), lumen size 2.0 mm (0.7 – 5), PSD diameter 2.5cm (1.4-8.0) and stricture length 10.0 cm (2-50). From the time of PSD detection, 46.8% (37) required stricture surgery within median of 13 months (0-115) and 26.5% (21) needed hospitalization for CD within median of 7 months (0-86). A larger PSD size (mean 3.0 cm vs 2.4 cm; p = 0.01) was associated with an increased likelihood of requiring surgery (p = 0.01), but not hospitalization. Additionally, corticosteroid use was associated with both outcomes (p = 0.04). Conclusion Nearly 50% of patients with small bowel CD strictures and PSD required surgical intervention within a median of 13 months. PSD size and steroid use were predictive of disease progression, suggesting that IUS can be valuable in prognosis assessment and guiding treatment timing. References: 1. Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, et al. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019;68(6):1115–26. 2. Maehata Y, Nagata Y, Moriyama T, Matsuno Y, Hirano A, Umeno J, et al. Risk of surgery in patients with stricturing type of Crohn’s disease at the initial diagnosis: a single center experience. Intest Res. 2019;17(3):357–64. 3. Rieder F, Baker ME, Bruining DH, Fidler JL, Ehman EC, Sheedy SP, et al. Reliability of MR Enterography Features for Describing Fibrostenosing Crohn Disease. Radiology. 2024;312(2):e233039. 4. Rieder F, Ma C, Hanzel J, Fletcher JG, Baker ME, Wang Z, et al. Reliability of CT Enterography for Describing Fibrostenosing Crohn Disease. Radiology. 2024;312(2):e233038. 5. Allocca M, Bonifacio C, Fiorino G, Spinelli A, Furfaro F, Balzarini L, et al. Efficacy of tumour necrosis factor antagonists in stricturing Crohn’s disease: A tertiary center real-life experience. Dig Liver Dis. 2017;49(8):872–7. Conflict of interest: Reji, Rohita: No conflict of interest O’Brien, Maureen: No conflict of interest Rosentreter, Ryan: No conflict of interest Aldarwish, Alia: No conflict of interest Besney, Jonathan: No conflict of interest Ingram, Richard James Michael: Consultancy fees: AbbVie, Amgen, CellTrion, Eli Lilly, J & J Innovative Medicine, Pfizer, Sanofi, Takeda Pharmaceuticals. Speakers’ honoraria: AbbVie, Amgen, BioJAMP, Eli Lilly, Pfizer, Takeda Pharmaceuticals. Stocks: AbbVie, Eli Lilly, Merck (discretionary managed). Kaplan, Gilaad: Grant: Dr. Kaplan received grants for research from Ferring and for educational activities from AbbVie, Bristol Myers Squibb, Ferring, Fresenius-Kabi, Janssen, Pfizer, Takeda. Personal Fees: Dr. Kaplan has received honoraria for speaking or consultancy from AbbVie, Amgen, Janssen, Pfizer, and Takeda. Ma, Christopher: Consulting fees: AbbVie, Alimentiv, Amgen, Anaptys Bio, AVIR Pharma Inc, Bristol Myers Squibb, Celltrion, Domain Therapeutics, Eupraxia, Eli Lilly, Ferring, Forte Biosciences, Fresenius Kabi, Gilead, Janssen, McKesson, Merck, Mirador Therapeutics, Pendopharm, Pfizer, Roche, Sanofi, Takeda, Tillotts Pharma Speaker’s fees: AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Eli Lilly, Ferring, Fresenius Kabi, Janssen, Merck, Organon, Pendopharm, Pfizer, Sanofi, Takeda, Tillotts Pharma Royalties: Springer Publishing Research Support: AbbVie, Eli Lilly, Ferring, Pfizer Panaccione, Remo: Grant: Abbvie, Janssen, Pfizer, Takeda Other: Consultant for: Abbott, AbbVie, Abbivax, Alimentiv (formerly Robarts), Amgen, AnaptysBio, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JBio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Prometheus Biosciences, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Spyre Therapeutics, Takeda Pharmaceuticals, Theravance Biopharma, Trellus, Union Biopharma, Viatris, Ventyx, UCB Speaker’s Fees for: AbbVie, Amgen, Arena Pharmaceuticals, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Gilead Sciences, Janssen, Merck, Organon, Pfizer, Roche, Sandoz, Shire, Takeda Pharmaceuticals Advisory Boards for: AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JBio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pfizer, Progenity, Protagonist Therapeutics, Roche, SandozShire, Sublimity Therapeutics, Takeda Pharmaceuticals, Ventyx. Seow, Cynthia: No conflict of interest Rieder, Florian: Personal Fees: Adiso, Adnovate, Agomab, Allergan, AbbVie, Arena, Astra Zeneca, Boehringer-Ingelheim, Celgene/BMS, Celltrion, CDISC, Celsius, Cowen, Ferring, Galapagos, Galmed, Genentech, Gilead, Gossamer, Granite, Guidepoint, Helmsley, Horizon Therapeutics, Image Analysis Limited, Index Pharma, Landos, Jannsen, Koutif, Mestag, Metacrine, Mopac, Morphic, Organovo, Origo, Palisade, Pfizer, Pliant, Prometheus Biosciences, Receptos, RedX, Roche, Samsung, Sanofi, Surmodics, Surrozen, Takeda, Techlab, Teva, Theravance, Thetis, UCB, Ysios, 89Bio St-Pierre, Joelle: Consultant for Pfizer, Abbvie, Eli Lilly and Pendopharm, and speaker for Takeda. Novak, Kerri L.: Research Grants: Helmsley Trust, Pfizer, Janssen Adboard, consulting fees: Abbvie, Janssen, Pfizer, Pendopharm, Takeda, Elli Lilly, Celltrion, Bristal Myers Non financial support (ultrasound machine) McKesson Pharmcy. Pfizer, Celltrion Dr. Lu, Cathy: Advisory board - Abbvie, Johnson and Johnson, Takeda, Ferring, Merck, Celltrion, Lilly, Pfizer, Pendopharm, Agomab. Research Funding - Abbvie, Helmsley Charitable Trust, Alberta Innovates