Endoscopic Stricturotomy Shows Promise Treating IBD Complications

Martin Lukas, MD

New data presented during the Crohn’s and Colitis Congress 2022 Annual Meeting show endoscopic stricturotomy could be the first option for treating common complications associated with inflammatory bowel disease (IBD).

A team, led by Martin Lukas, MD, IBD Clinical and Research Center, ISCARE, examined previous results on endoscopic stricturotomy at a single tertiary hospital.

The procedure

Primary strictures and secondary anastomotic strictures are both common complications for patients with IBD, particularly those with Crohn’s disease. Currently the best way to treat this complication is balloon dilation.

However, albeit with limited data due to small sample sizes and few sites, endoscopic stricturotomy is a promising, but unproven approach.

In the study, the investigators examined endoscopic stricturotomy performed in patients with IBD between September 2018 and April 2021. The team collected data on demographics, disease characteristics, procedure details, and outcomes.

They defined technical success as the ability to pass the scope through the stricture following the procedure.

Success

Complications included perforation and the immediate or delayed bleeding with the need for intervention or hospitalization.

The investigators identified 92 procedures performed in 67 patients, 60 of which had Crohn’s disease and 7 of which had ulcerative colitis. The patient population was 46.3% male and the mean age was 43.9 12.5 years and mean disease duration was 14.6 9.7 years.

In addition, 73.1% (n = 49) of patients had a single endoscopic stricturotomy performed, while 26.9% (n = 18) had multiple procedures.

The majority of locations occurred in the surgical anastomosis site (89.1%; n = 82), while the remaining 10 locations occurred in the anal canal. Anastomotic strictures included ileo-colonic (64.1%), colo-colonic (9.8%), ileo-rectal (3.3%), and ileal pouch-anal (12%) anastomoses.

Also, previous endoscopic balloon dilation was attempted in 53.3% of the procedures, while 27.2% of analyzed procedures were preceded by earlier endoscopic stricturotomy.

The investigators deemed technical success for 90.2% (n = 83) of endoscopic stricturotomies, with 4 cases having complications of delayed bleeding, which were managed conservatively.

After the mean follow-up time of 18.1 10.0 months, the cumulative probability of reintervention at 6 months was 30.2% (95% CI, 15.6-46.2%), 40.3% (95% CI, 25.5-54.6%) at 12 months, and 48.8% (95% CI, 34,0-62,1%) at 18 months.

The investigators also analyzed outcomes for various demographics and found time to reintervention was not significantly impacted by previous intervention, age of the anastomosis, sex or age of the patients, concurrent therapy, and specific endoscopic stricturotomy technique employed.

“[Endoscopic stricturotomy] is a novel endoscopic technique, which is both efficacious and safe to be performed in patients with IBD-related strictures,” the authors wrote.

The study, “ENDOSCOPIC STRICTUROTOMY – A NOVEL THERAPEUTIC MODALITY FOR IBD-RELATED STRICTURES: FIRST EUROPEAN EXPERIENCE,” was published online by the Crohn’s and Colitis Congress.