S816 Safety and Efficacy of Endoscopic Dilation of Small Bowel Crohn’s Disease Strictures via Ileostomy

Introduction: Crohn’s disease (CD) manifests as a variety of phenotypes of which fibrostenotic strictures signify an increased risk of progression to obstructive complications. Medical management of stricturing CD is limited and often requires surgical interventions. Endoscopic balloon dilation (EBD) has emerged as an alternative to surgery in CD strictures. Data on EBD in CD strictures of patients with ileostomy is limited. Methods: All CD patients who had undergone EBD for strictures via ileoscopies through a small bowel stoma performed at a tertiary medical center from February 2010 to December 2021 were included. Strictures were defined as the inability to pass an upper endoscope. Patients were followed until the date of stricture-related surgery or at least one month post EBD. Data on technical (ability to pass the scope after dilation) and clinical (symptom improvement) success, long-term efficacy, and complications were investigated. (Figure) Results: In total, 34 CD patients (59% female) with end ileostomies (88.2%) or diverting loop ileostomies (11.8%) were identified with a median follow-up of 18.3 months [Interquartile Range (IQR) 6.8, 45.3]. Median age at index EBD was 45 years [IQR 31.6, 56.7] The median maximal balloon dilation diameter at index EBD was 16.7 mm [IQR13.1, 18.3]. Technical success was achieved in 100% of the EBDs, with 91% of patients endorsing clinical success (improvement in symptoms). Obstructive symptoms recurred in 32% of patients. Repeat EBD was performed in 52.9% with a median time to dilation of 7.4 months [95% CI: 4, 17.8]. Furthermore, 41.2% of patients underwent one additional EBD and 14.7% had two or more additional EBDs. During follow-up, 47.1% underwent stricture-related surgery with a median time to resection of 35.2 months [95% C1: 21.1, 116.6]. There were no short-term complications within a week however long-term complications included an abscess in one patient and a fistula in another patient. (Table) Conclusion: EBD of small bowel CD-associated strictures through an ileostomy has a high rate of technical and clinical success with robust long-term efficacy. Serial dilation of the same stricture is feasible and the complication rate is low. EBD may allow clinicians to effectively postpone surgery for CD strictures in patients with an ileostomy.Figure 1.: (A) Kaplan-Meier cumulative incidence hazard curves for time to repeat EBD. (B) Kaplan-Meier cumulative incidence hazard curves for time to stricture-related surgery. Table 1. - Summary of descriptive statistics by status of repeat EBD Variable Level All (n=34) No (n=16) Yes (n=18) P-value N Age 45.0 [31.6;59.0] 51.8 [31.9;56.7] 41.3 [32.1;60.2] 0.918 34 Sex Female 20 (58.8%) 12 (75.0%) 8 (44.4%) 0.145 34 Male 14 (41.2%) 4 (25.0%) 10 (55.6%) BMI at time of EBD 22.5 [20.7;26.3] 23.0 [20.8;26.4] 22.2 [20.7;26.3] 0.986 34 Time since CD diagnosis (years) 20.1 [15.1;32.1] 20.3 [16.1;34.3] 19.4 [14.4;31.4] 0.666 34 Smoking History Non-Smoker 25 (73.5%) 12 (75.0%) 13 (72.2%) 0.737 34 Smoker 3 (8.82%) 2 (12.5%) 1 (5.56%) Former Smoker 6 (17.6%) 2 (12.5%) 4 (22.2%) Disease Location Stomach 2 (5.88%) 1 (6.25%) 1 (5.56%) >0.999 34 Duodenum 6 (17.6%) 5 (31.2%) 1 (5.56%) 0.078 34 Jejunum/proximal ileum 15 (44.1%) 8 (50.0%) 7 (38.9%) 0.760 34 Ileum 34 (100%) 16 (100%) 18 (100%) N/A 34 Ileocecal 34 (100%) 16 (100%) 18 (100%) N/A 34 Colon 29 (85.3%) 13 (81.2%) 16 (88.9%) 0.648 34 Rectum 26 (76.5%) 11 (68.8%) 15 (83.3%) 0.429 34 Perianal 13 (38.2%) 3 (18.8%) 10 (55.6%) 0.064 34 Extraintestinal Manifestations (EIM) Yes 31 (93.9%) 13 (86.7%) 18 (100%) 0.199 34 Type of EIM Eyes) 1 (2.94%) 0 (0.00%) 1 (5.56%) >0.999 34 Oral Ulcers) 5 (14.7%) 2 (12.5%) 3 (16.7%) >0.999 34 Joints 5 (14.7%) 3 (18.8%) 2 (11.1%) 0.648 34 Skin 5 (14.7%) 1 (6.25%) 4 (22.2%) 0.340 34 Anemia 20 (58.8%) 7 (43.8%) 13 (72.2%) 0.182 34 PSC 1 (2.94%) 0 (0.00%) 1 (5.56%) >0.999 34 Malnutrition 25 (73.5%) 10 (62.5%) 15 (83.3%) 0.250 34 Hypoalbuminemia 25 (73.5%) 10 (62.5%) 15 (83.3%) 0.250 34 Other 1 (2.94%) 1 (6.25%) 0 (0.00%) 0.471 34 Montreal Classification B2 4 (11.8%) 3 (18.8%) 1 (5.56%) 0.219 34 B2p 7 (20.6%) 5 (31.2%) 2 (11.1%) 34 B3 5 (14.7%) 1 (6.25%) 4 (22.2%) B3p 18 (52.9%) 7 (43.8%) 11 (61.1%) Number of prior surgeries 6.00 [4.25;8.00] 5.50 [3.50;7.25] 7.00 [5.25;9.50] 0.150 Ostomy type at time of EBD End Loop Ileostomy 30 (88.2%) 15 (93.8%) 15 (83.3%) 0.604 34 Diverting Loop Ileostomy 4 (11.8%) 1 (6.25%) 3 (16.7%) Time from date of ostomy creation to index EBD (years) 4.13 [2.07;7.02] 3.20 [1.91;7.80] 4.33 [2.95;6.90] 0.629 34 Stricture balloon size (cm) 1.80 [1.20;2.00] 1.80 [1.35;2.00] 1.50 [1.20;1.80] 0.315 19 Stricture maximum diameter of dilation during EBD (cm) 1.67 [1.31;1.83] 1.80 [1.35;2.00] 1.50 [1.20;1.80] 0.315 28 Total Number of strictures 1 25 (73.5%) 14 (87.5%) 11 (61.1%) 0.125 34 2 9 (26.5%) 2 (12.5%) 7 (38.9%) Hemoglobin (g/dL) 12.5 (2.26) 12.4 (2.04) 12.6 (2.49) 0.828 23 Albumin (g/dL) 3.71 (0.65) 3.58 (0.38) 3.84 (0.82) 0.365 21 CTE or MRE within 6 months prior to Index EBD 12 (35.3%) 11 (68.8%) 11 (61.1%) 0.916 34

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