S1702 Endoscopic Balloon Dilation of Inflammatory Crohn’s Disease Strictures Is Safe and Effective: A Retrospective Case Control Study

Introduction: Crohn’s disease (CD) is a chronic inflammatory condition often of a progressive nature. It can lead to strictures, which can be inflammatory, fibrostenotic, or a combination both. For short intestinal strictures, endoscopic balloon dilation (EBD) offers a less invasive alternative to surgical resection or stricturoplasty. However, concern remains amongst endoscopists around performing EBD in intestinal inflammatory strictures due to risk of perforation. We evaluated the efficacy and complication rates of endoscopic balloon dilation performed in Crohn’s disease strictures, with emphasis on ulcerated strictures. Methods: We conducted a retrospective cohort study of CD patients undergoing EBD at large hospital centers in Vancouver, BC, Canada. Data were extracted on demographics, age at CD diagnosis, smoking status, medication use, ulceration status at the stricture site, anastomotic strictures, and fluoroscopy use. Complications, all-cause hospitalizations within 30 days, and need for surgery were recorded. Descriptive statistics summarized demographics and procedure characteristics. Fisher’s exact test assessed the association between ulceration status and adverse events. Logistic regression modeling could not be performed due to low event counts. Results: A total of 377 balloon dilations were performed on 74 CD patients (44 males, 30 females), with an average of 5.1 dilations per patient. Each procedure achieved an average stricture dilation of 3 mm. Ulcerations at the stricture site were documented in 80 procedures, and anastomotic strictures were noted in 133 procedures. Eight complications (2.1%) occurred, including post-procedural bleeding (n = 5), postprocedural abscess (n = 1), mucosal trauma (n = 1), and perforation (n = 1). All-cause 30-day hospitalization occurred in 21 patients (5.6%). Twenty-2 patients (29.7%) required surgery. Ulceration at the stricture site was not a significant predictor of adverse events (OR 1.61, 95% CI 0.66–3.91, P = 0.36). Conclusion: EBD is a safe and effective therapy for CD strictures. Despite theoretical concerns, ulceration at the stricture site did not significantly increase complications or postprocedural hospitalizations. Overall complication rates were low. Nearly one-third of patients ultimately required surgery, underscoring the progressive nature of Crohn’s Disease, thereby highlighting appropriate treatment at an earlier stage of the disease.