P0567An Analysis of Long-term Outcomes in Crohn’s Patients with Small Bowel Strictures Dilated via Balloon Endoscopy: Factors Associated with Surgery and a New Predictive Model

Abstract Background Crohn’s disease (CD) has a hallmark of the formation of intestinal strictures that may ultimately require surgical resection.1 Studies have documented the efficacy of endoscopic balloon dilation (EBD) using balloon-assisted endoscopy (BAE) for stricture management 2–4, yet a subset of patients still require surgical intervention. Factors predicting the need for surgical intervention in patients with stricturing CD are poorly understood. This study analyzed outcomes of CD patients who underwent balloon dilation of small bowel strictures to identify factors that predict the need for surgery. Methods A retrospective review of CD patients ≥ 18 years of age who underwent one or more BAE with small bowel stricture dilations between January 2012 and January 2024 was conducted at the University of Alberta Hospital. Univariate and multivariate logistic regression analyses were performed to identify factors predicting need for surgery. Results Outcomes for 134 patients who underwent a total of 353 BAEs with stricture dilations were analyzed. Of the 134 patients, 45 (33.6 %) underwent surgery. Thirty-nine patients (86.7 %) underwent surgery for symptoms relapse or ongoing persistence of symptoms despite dilation. Three patients underwent surgery for malignancy, two for perforation and one for anemia. The mean number of BAEs performed per patient was 2.6. The median time from last BAE to surgery was 3.73 months (range 0–35.4). Univariate logistic regression analysis showed active inflammation (OR = 1.36, p = 0.045), minimum dilation diameter (OR = 0.74, p = 0.0003), and non-traversable stricture(s) (OR = 3.54, p = 0.005) were significantly associated with the need for surgery. The number of BAEs performed per patient (p = 0.42) and the total number of dilations per person (p = 0.881) were not significant. In multivariate logistic regression modelling, the variables of significance were age, biologics use, active inflammation, minimum dilation diameter, number of BAEs performed, number of dilations performed for de novo strictures, and presence of a non-traversable stricture. This model demonstrated a bootstrap-corrected area under the curve (AUC) of 0.72. A cutoff of 13.5 mm minimum achieved dilation diameter was the strongest predictor of who would need surgery. Increasing dilation diameter was associated with a decreasing likelihood of surgery (p = 0.0003). Conclusion This analysis identifies promising predictive indicators of the need for surgery in CD patients with small bowel strictures. Minimum dilation diameter was statistically significant in both univariate and multivariate analysis, with a diameter of 13.5 mm best separating the surgical and non-surgical groups suggesting this may be an important therapeutic target via BAE. References: 1. Moghadamyeghaneh Z, Carmichael JC, Mills SD, Pigazzi A, Stamos MJ. Outcomes of Bowel Resection in Patients with Crohn’s Disease. Am Surg. Oct 2015;81(10):1021-7. 2. Hong SN, Kim JE, Kim ER, Chang DK, Kim YH. Enteroscopic Balloon Dilation in Small Bowel Stricturing Crohn’s Disease: Long-Term Outcomes and Risk Factors for Surgery in a Single-Center Prospective Observational Study. United European Gastroenterol J. Jul 2025;13(6):958-970. doi:10.1002/ueg2.12775 3. Halloran BP, Reeson M, Teshima C, et al. Stricture dilation via balloon-assisted endoscopy in Crohn’s disease: approach and intraprocedural outcomes with the single-balloon and double-balloon systems. Therap Adv Gastroenterol. 2024;17:17562848241230904. doi:10.1177/17562848241230904 4. Hirai F, Andoh A, Ueno F, et al. Efficacy of Endoscopic Balloon Dilation for Small Bowel Strictures in Patients With Crohn’s Disease: A Nationwide, Multi-centre, Open-label, Prospective Cohort Study. J Crohns Colitis. Mar 28 2018;12(4):394-401. doi:10.1093/ecco-jcc/jjx159 Conflict of interest: Halloran, Brendan: Speaker/Consultant - Johnson and Johnson, Abbvie, Takeda, Pendopharm, Fujifilm, Celltrion, Shire, Pfizer Research Grants - Johnson and Johnson, Abbvie, Pfizer Oguro, Kunihiko: N/A Bowron, Joel: No conflict of interest Tan, Qiming: No conflict of interest Fazal, Muhammad Anas: No conflict of interest Parsons, Denise: Denise Parsons has received salary support from a Pfizer grant. Peerani, Farhad: Dr. Peerani has received speaker or advisory board fees from Janssen, Takeda, AbbVie, Pfizer, Ferring, and Eli Lilly. Gozdzik, Michal: Michal Gozdzik has received speaker fees from Pfizer and Johnson & Johnson and participated in consultancy meetings with AbbVie, Takeda, Celltrion, Ferring and Pendopharm Wong, Karen: Abbvie - honoraria speaker / advisory board Janssen - honoraria speaker / advisory board Kroeker, Karen: No conflict of interest Hoentjen, Frank: Frank Hoentjen has served on advisory boards or as speaker for Abbvie, CCRN, Janssen, Takeda, Pfizer, Celltrion, Teva, Amgen and Pendopharm, and has received independent research funding from Celltrion, Janssen, Abbvie, and Takeda. Wasilenko, Shawn: No conflict of interest Zepeda-Gomez, Sergio: No conflict of interest