Abstract Background Surgical risk remains high for patients with stricturing and penetrating Crohn’s disease (CD) despite modern biologic therapy (1). A coordinated multimodal approach may optimise outcomes (2). Our centre integrates enteral nutrition (EN), biologic optimisation, short-term corticosteroids, and endoscopic balloon dilatation (EBD) where appropriate. We assessed clinical, biochemical, nutritional and radiologic outcomes of our approach in adults with stricturing and/or penetrating CD. Methods We conducted a retrospective study of adults with active stricturing or stricturing with penetrating CD treated between 2019 and 2023, with follow-up to February 2025. Eligible patients completed 6 weeks of exclusive or partial EN and had 3 months follow-up. Management incorporated EN, biologic initiation/ optimisation, corticosteroids, and EBD as indicated. Patients unable to tolerate exclusive EN (EEN) were offered partial EN (PEN), defined as 70% caloric intake from EN with the remainder from the Crohn’s Disease Exclusion Diet (CDED). The primary outcome was surgery-free survival (SFS). Secondary outcomes were patient-reported outcome (PRO-2) scores, C-reactive protein (CRP), albumin, body mass index (BMI), corticosteroid use, and simplified MaRIA (sMaRIA) scores. Results Thirty-five patients met inclusion criteria (57% stricturing, 43% stricturing with penetrating disease). Twenty-eight (80%) received EEN, and 7 (20%) received PEN. Twelve (34%) underwent EBD. Six patients (17%) required surgery during follow-up. SFS was 88.6% at 12 months, 85.5% at 24 months, and 81.0% at 36 months (Figure 1). No significant differences in SFS were observed by biologic class, EN strategy, or EBD use. At 3 months, significant improvements were seen in CRP (35.8 vs 11.6 mg/L, p = 0.021), albumin (36.1 vs 38.9 g/L, p = 0.004) and PRO-2 (8.15 vs 1.73, p 0.001), with stable BMI (Table 1). Steroid use fell from 74% to 31% (p 0.001). Improvements were sustained at 12 months. Radiologic response was most pronounced at 12 months, with mean sMaRIA reductions of -1.41 (p = 0.01) at 12 months and -2.22 (p = 0.02) at 12 months. Conclusion Adults with stricturing and/or penetrating CD treated using a structured multimodal program achieved high surgery-free survival and sustained clinical, biochemical, and radiologic improvement. EN-based induction, combined with biologic optimisation and selective EBD, is feasible and clinically meaningful in real-world practice. Prospective studies are required to validate this integrated care model and identify patients most likely to benefit. References: (1) Bossuyt P, Debeuckelaere C, Ferrante M, De Buck Van Overstraeten A, Vanbeckevoort D, Billiet T, et al. Risk Stratification for Surgery in Stricturing Ileal Crohn’s Disease: The BACARDI Risk Model. Journal of Crohn’s and Colitis. 2018 Jan 5;12(1):32–8. (2) Hu D, Ren J, Wang G, Li G, Liu S, Yan D, et al. Exclusive Enteral Nutritional Therapy Can Relieve Inflammatory Bowel Stricture in Crohn’s Disease. Journal of Clinical Gastroenterology. 2014 Oct;48(9):790–5. Conflict of interest: Dr. Pajes, A Nico Nahar: I have no conflicts of interest to disclose. Sheiban, Alexander: I have no conflicts of interest to disclose. Yang, Jessica: I have no conflicts of interest to disclose. Maguire, Brook: I have no conflicts of interest to disclose. Ghali, Mark: No conflicts. Monro, Emily: I have no conflict of interests to disclose. Au, Michael: Received research support from Ferring pharmaceuticals and Norgine Mitrev, Nikola: Received education grants and/or research support from Janssen, Takeda, Pfizer, Ferring, AbbVie, Dr Falk, Norgine, Sandoz, Celltrion, Chiesi, DHM, Organon, JustMeds, CSL Seqirus, GSK. Received speaker support from Janssen, Takeda, Pfizer and Ferring. Board director of IBD Sydney, a not-for-profit organisation. Leong, Rupert: advisory board: AbbVie, Aspen, BMS, Celgene, Celltrion, Chiesi, Ferring, Glutagen, Hospira, Janssen, Lilly, MSD, Novartis, Pfizer, Prometheus Biosciences, Takeda, Spyre, Roche research grants: Joanna Tiddy USYD, McCusker Charitable Foundation, Celltrion, Shire, Janssen, Takeda, Gastroenterological Society of Australia, NHMRC, Gutsy Group, Pfizer Kariyawasam, Viraj: Educational grants or research support – Ferring, Janssen, AbbVie, Takeda, Shire, WSLHD Research and Education network, Crohn’s and Colitis USA Speaker fees – Janssen, AbbVie, Ferring, Takeda, Pfizer, Shire, Chiesi, Celltrion, GSK, Eli-Lilly, Research Review, Limbic Advisory boards – Janssen, Takeda, Ferring, AbbVie Board director- IBD Sydney organisation (not for profit)
Pajes et al. (2026) studied this question.