S1242 Through-the-Scope Dilation in Stenotic Crohn's Disease: Results of a Large Cohort of Consecutive Patients

BACKGROUND: Sub-occlusions are frequent complications of Crohn's disease (CD). They are usually caused by stenosis, which can be due to recurrent CD or ischemic anastomosis. Through-the-scope balloon dilation (TTS) is the only alternative to intestinal resection or stricturoplasty for the treatment of intestinal strictures. Previous studies have reported a long-term symptomatic benefit of TTS balloon dilation in CD ranging from 48% and 66%. The aim of this study is to evaluate safety and efficacy of repeated TTS balloon dilations in CD strictures. PATIENTS AND METHODS: We retrospectively analyzed consecutive endoscopy protocols of all CD patients who underwent colonoscopy or rectosigmoidoscopy with TTS balloon dilation between 2000 and 2007, in the hospital databases of University Hospital of Lausanne and Kantonspital St Gallen, Switzerland. All patients had histologically proven CD that did not improve under medical CD treatment, including 5-amino salicylic acid, azathioprine, 6-mercaptopurine, methotrexate, budesonide, prednisone or anti-TNFα. Hydrostatic TTS balloon dilation was performed using Wilson Cook/Boston Scientific balloons progressively inflated to maximal pressure for 60 seconds. RESULTS: Sixty-one consecutive patients (33 females, 28 males), mean age 37±11 years, underwent dilation for a total of 237 dilations. Mean balloon diameter was 18mm (range 10-25mm). An inflammatory activity was observed in 75% of strictures, 129 dilations were performed on anastomotic strictures (54%), the other dilations were performed on surgically naive bowel (21 in terminal ileum, 11 at the ileo-cecal valve,4 in the right colon, 21 in the left colon, 51 in the rectoanal region). Mean number of dilations was 2.25 (interval range 1 to 21) per stricture. All patients had symptoms relief post dilation, mean time before repeated dilation was 132 days (range: 3-1495 days). One perforation occured, which required surgery. CONCLUSION: TTS balloon dilation is a safe and effective treatment of CD strictures. It can be used to treat anastomotic as well as disease-induced stenosis, independently of inflammatory status. Multiple TTS balloon dilations of the same stenosis is often required to improve symptoms. Repeated TTS dilations did not increase the risk of complications.