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Sunday Poster Session

Category: IBD

P0761 - Clinical Outcomes of Endoscopic Balloon Dilation for Upper Gastrointestinal Crohn’s Disease-Associated Strictures: A Cohort Study

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Has Audio
Brittany Baker, MS, DO1, Meera Iyengar, MD1, Mahmoud Rahal, MD1, Justin Ceh, MD1, Hisham Wehbe, MD1, Chirag Shah, MD2, Monika Fischer, MD, MSc, FACG3, Megan Walker, MD3, Sashidhar Sagi, MD1, Matthew Bohm, DO4
1Indiana University School of Medicine, Indianapolis, IN; 2IU School of Medicine, Indianapolis, IN; 3Indiana University, Indianapolis, IN; 4Indiana University Hospital, Indianapolis, IN

Introduction: There are limited studies to elucidate the potential benefit of minimally invasive interventions such as endoscopic balloon dilation (EBD) for the treatment of Upper Gastrointestinal Crohn’s Disease-related strictures. The aim of this study is to evaluate the safety and efficacy of EBD in delaying or preventing surgery in patients with upper GI (UGI) Crohn’s disease (CD).

Methods: This is a retrospective cohort study including all patients with UGI CD undergoing EBD at a tertiary academic center between 01/2007 and 12/2021. Data for demographics, disease characteristics, stricture characteristics, surgical history, medication history, need for surgical intervention, time to surgical intervention, and need for re-dilation were collected. Patient outcomes were followed from their index dilation up to 5 years post dilation.

Results: 24 CD patients with UGI strictures (50% female) with a mean age of 41 years underwent EBD during the study period (26 distinct strictures with 47 total dilations). Locations of strictures were gastric (10), duodenal (9), gastroduodenal (3) and jejunal in 4 patients. Mean duration from CD diagnosis to first stricture dilation is 11 years. Mean age at diagnosis was 25 years old. Among these patients, 8/24 (33%) required surgery for CD-related stricture during the 5-year follow-up period. 12/26 strictures (46%) required re-dilation. Technical success was achieved in 88% of cases. The mean time to re-dilation and mean time to stricture-related surgery after first dilation was 357 days and 109 days, respectively. One patient had a mild complication post-dilation. 40% of gastric strictures required surgical resection compared to 11% of duodenal strictures and 25% of jejunal strictures.

Discussion: Dilation of strictures in patients with UGI CD has a high rate of technical success, with minimal complication rate. Almost a third of patients required surgery. Gastric strictures were more likely to require surgery compared to duodenal strictures.

 

All Patients (n=24) 

Surgery post-dilation 

(n=8) 

No surgery post-dilation 

(n=16) 

p-value 

Female, n (%)  

12 (50%) 

4 (50%) 

8 (50%) 

1.0000 

Age at dilation (years), mean (std) 

41.47 (19.79) 

37.6 (25.07) 

43.08 (18.20) 

0.6186 

BMI, mean (std) 

24.21 (4.91) 

21.50 (4.06) 

25.56 (4.84) 

0.0538 

Smoking Status, n (%) 

 

 

 

0.3676 

Current 

2 (8%)

0 

2 (13%)

 

Never 

20 (83%)

8 (100%)

12 (75%)

 

Past 

2 (8%)

0 

2 (13%)

 

Age at Diagnosis 

 

 

 

0.8333 

A1 (< 16 years) 

5 (26%)

2 (28%)

3 (25%)

 

A2 (17-40 years) 

9 (47%)

4 (57%)

5 (42%)

 

     A3 ( >40 years) 

5 (26%)

1 (14%)

4 (33%)

 

Behavior of Disease, n (%) 

 

 

 

0.6177 

   Stricturing  

17 (81%)

6 (75%)

11 (85%)

 

Stricturing and Penetrating 

4 (19%)

2 (25%)

2 (15%)

 

Prednisone at dilation, n (%) 

5 (20.83%) 

1 (12.5%) 

4 (25.00%) 

0.6311 

Endoscopic Severity at time dilation, n (%) 

 

 

 

0.3627 

Remission 

2 (8%)

1 (12.5)%

1 (6%)

 

Mild 

5 (21%)

0 

5 (31%)

 

Moderate 

9 (38%)

4 (50%)

5 (31%)

 

Severe 

8 (33%)

3 (37.%)

5 (31%)

 

Stricture type, n (%) 

 

 

 

1.0000 

De Novo 

21 (91%) 

7 (100%) 

14 (88%) 

 

Anastomotic 

2 (9%)

0 

2 (12%)

 

Need for redilation, n (%) 

11 (45.83%) 

4 (50.00%) 

7 (43.75%) 

1.0000 

Location of stricture, n (%)

 

 

 

 

Gastric

10 (38%)

6 (40%)

4 (60%)

 

Duodenal

9 (35%)

1 (11%)

8 (89%)

 

Gastroduodenal

3 (12%)

1 (33%)

3 (67%)

 

Jejunal

4 (15%)

1 (25%)

3 (75%)

 



Disclosures:
Brittany Baker indicated no relevant financial relationships.
Meera Iyengar indicated no relevant financial relationships.
Mahmoud Rahal indicated no relevant financial relationships.
Justin Ceh indicated no relevant financial relationships.
Hisham Wehbe indicated no relevant financial relationships.
Chirag Shah indicated no relevant financial relationships.
Monika Fischer: AbbVie – Advisor or Review Panel Member. Bristol Myers Squibb – Advisor or Review Panel Member, Speakers Bureau. Eli Lilly and Company – Advisor or Review Panel Member. Ferring – Advisor or Review Panel Member, DSMB. Janssen – Speakers Bureau. Pfizer – Advisor or Review Panel Member. Rebiotix – DSMB. scioto – Advisor or Review Panel Member. Seres – Advisor or Review Panel Member.
Megan Walker indicated no relevant financial relationships.
Sashidhar Sagi indicated no relevant financial relationships.
Matthew Bohm indicated no relevant financial relationships.


Brittany Baker, MS, DO1, Meera Iyengar, MD1, Mahmoud Rahal, MD1, Justin Ceh, MD1, Hisham Wehbe, MD1, Chirag Shah, MD2, Monika Fischer, MD, MSc, FACG3, Megan Walker, MD3, Sashidhar Sagi, MD1, Matthew Bohm, DO4. P0761 - Clinical Outcomes of Endoscopic Balloon Dilation for Upper Gastrointestinal Crohn’s Disease-Associated Strictures: A Cohort Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.