ENDOSCOPIC STRICTUROTOMY - A NOVEL THERAPEUTIC MODALITY FOR IBD-RELATED STRICTURES: FIRST EUROPEAN EXPERIENCE

Aims Strictures, both primary and secondary anastomotic strictures, are common complications in patients with inflammatory bowel diseases (IBD) especially Crohn´s disease (CD). Balloon dilation has been the gold standard in the endoscopic treatment of these strictures. Endoscopic stricturotomy (ESt) represent a promising novel approach, however, the data published on this method so far is limited to a single US center.

Methods All ESts performed in IBD patients between September 2018 and November 2019 in our tertiary IBD center were included. Data on demographics, disease characteristics, procedure details and outcomes were analyzed. Technical success was defined as an ability to pass the scope through the stricture following the procedure.

Results In total, 46 procedures were performed in 39 patients (34 with Crohn´s disease, CD, and 5 with ulcerative colitis, UC) Among these 38.5% were males. Mean age was 43.5±10.9 years and mean disease duration was 17.4±9.9 years. Single ESt was done in 82.1% of patients, while 17.9% required multiple procedures. Most common location of stricture was surgical anastomosis site (43, 93.5%), while remaining 3 were located at anal canal. Anastomotic strictures included ileo-colonic (71.7%), ileo-rectal (4.3%), and ileal pouch-anal (17.4%) anastomoses. Previous endoscopic balloon dilation (EBD) was attempted in 78.3% cases. Technical success was achieved in 42 ESts (91.3%), complications occurred in two cases (both delayed bleeding, managed conservatively). After the mean follow-up time of 8.2±4.3 months, cumulative probability of reintervention (ESt, EBD or surgery) at 6 months was 16.1% (95% CI 1.7-44.2%).

Conclusions ESt is a novel endoscopic technique, which is both highly efficacious and safe to be performed in patients with IBD-related strictures.