LAUSR

ID: 3520545 OUTCOMES OF ENDOSCOPIC BALLOON DILATION FOR ILEOCOLONIC STRICTURES IN CROHN’S DISEASE PATIENTS WITH A HISTORY OF ABDOMINAL SURGERY Yuki Ohta*, Jun Kato, Tsubasa Ishikawa, Wataru Shiratori, Tatsuya Kaneko, Mamoru Tokunaga, Hirotaka Oura, Kengo Kanayama, Naoki Akizue, Takashi Taida, Kenichiro Okimoto, Keiko Saito, Tomoaki Matsumura, Makoto Arai, Naoya Kato Background and Aim: Intestinal stenosis can occur during the long-term course of Crohn’s disease (CD) due to resistance to medical treatment or delayed diagnosis. In those cases, patients usually have to undergo abdominal surgery. Endoscopic balloon dilation (EBD) is a potential treatment for ileocolonic stenosis as an alternative to surgery, and the clinical results of the procedure have been reported. Although EBD may be beneficial particularly in CD patients with a history of abdominal surgery due to possible avoidance of repeated surgery, the outcomes of EBD in such patients have scarcely been evaluated. The aim of this study was to determine the usefulness of EBD in postoperative CD patients. Methods: Patients with CD who underwent EBD for ileocolonic stenosis between August 2008 and September 2020 at our institution were analyzed in the study. All patients had obstructive symptoms due to stenosis, and successful EBD was defined as improvement in clinical symptoms with adequate stenosis expansion. EBD for stricture in the small bowel was performed using balloon-assisted enteroscopy. The following analyses were performed based on patients with successful EBD. First, the cumulative surgery-free rate and cumulative redilatation-free rate were compared between patients with and without a history of abdominal surgery. Then risk factors for reoperation and redilation were identified using variables including the presence or absence of a history of abdominal surgery. In addition, factors for the avoidance of reoperation or redilatation among subjects with a history of abdominal surgery were investigated. Results: During the follow-up period, EBD was attempted in 52 patients with CD, and was successful in 50 (96.2%) cases. EBD using balloon-assisted enteroscopy was applied for 35 patients with stricture in the small bowel. Of 50 successful EBD cases, 21 (42%) had a history of abdominal surgery. Of 21 patients with a history of surgery, 8 received EBD for the anastomotic site. The cumulative surgeryfree rates 3 years after EBD in patients with and without a history of abdominal surgery were 72.0% and 84.5%, respectively (log-rank test pZ0.393). The cumulative redilatation-free rates 3 years after EBD were 34.0% and 38.4%, respectively (log-rank test pZ0.532). Among patients with a history of surgery, those with disease duration longer than 10 years were less likely to receive reoperation or redilatation than those with disease duration less than 10 years (log-rank test pZ0.048). Conclusion: The outcomes of EBD for patients with a history of abdominal surgery were comparable to those for patients without a history of abdominal surgery. EBD should be performed without hesitation even after surgery, particularly in patients with long disease duration.