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Poster presentations: Clinical: Therapy and Observation 2020

P370 Endoscopic balloon dilatation in paediatric stricturing Crohn’s disease: A retrospective collaborative study of the paediatric IBD Porto group of ESPGHAN

O. Ledder1, J. Viala2, D. Urlep3, D. Serban4, L. De Ridder5, M. Martinelli6, C. Romano7, S. Oliva8, S. Sharma9, M. Thomson9, D. Turner1, Paediatric IBD Porto Group of ESPGHAN

1Department of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, 2Department of paediatric gastroenterology, Hôpitaux de Paris, Paris, France, 3Department of Paediatric Gastroenterology, Ljubljana University Medical Centre, Ljubljana, Slovenia, 4Emergency Clinical Hospital for Children, 2nd Clinic of Pediatrics, Cluj-Napoca, Romania, 5Department of Paediatric Gastroenterology, Erasmus MC/Sophia Children′s Hospital, Rotterdam, The Netherlands, 6Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy, 7Department of Paediatric Gastroenterology, University of Messina, Messina, Italy, 8Department of Paediatric Gastroenterology, Sapienza University of Rome, Rome, Italy, 9Department of Paediatric Gastroenterology, Sheffield Children’s Hospital, Sheffield, UK

Background

Endoscopic balloon dilatation (EBD) is an effective management strategy in stricturing Crohn’s disease (CD). While adult studies showed a high success rate of improved symptoms and avoiding surgical intervention, very little has been published in children. We thus present a multi-centre retrospective cohort study of EBD in paediatric CD from 9 centres affiliated with the Paediatric IBD Porto group of ESPGHAN.

Methods

Demographics, imaging, serological data, clinical indices (including the newly-developed modified CD obstructive score (mCDOS)), post-EBD complications and need for surgical intervention were recorded on electronic case report forms.

Results

Thirty-nine balloon dilatations were performed on 34 children (20 (59%) male, mean age 14.3 ± 3.4 years, median disease duration 3.5 years (IQR 1.1–5.8)). Successful avoidance of surgical intervention was recorded in 26 (76%) children, during a median follow-up period of 24 weeks (IQR 8–24). There was an increase in number of patients in clinical remission (wPCDAI < 12.5) following EBD from 20% pre-dilation to 36% (ns), 53% (p = 0.017) and 57% (p = 0.015) at weeks 2, 8 and 24, respectively. There was a trend to reduced mCDOS, from 5 (IQR 0–15) at baseline to 5 (0–6.25) (ns), 5 (0–5) (p = 0.04), and 0 (0–7.5) (ns), respectively. The stricture was primary in 31 (79%) children (17 in the ileocecal valve (ICV) region, 3 in the terminal ileum, 9 in the colon and 1 in the duodenum), 7 of whom had multiple strictures. Eight (21%) children had an anastomotic stricture. Median stricture length was 3 cm (IQR 2–4.7), bowel wall thickness 7 mm (IQR 5–8) and median pre-stenotic dilatation of 4.5 cm (IQR 4–5). Median maximal dilatation diameter was 15 mm (IQR 12–18) with the successful passage of the colonoscope in 26/39 (67%). There were 3 (8%) post-dilatation complications including one bleed following rectal dilatation (with spontaneous resolution) and 2 perforations (1 duodenal perforation managed conservatively and 1 ICV perforation requiring surgical resection).

Conclusion

EBD is an effective and safe technique in paediatric stricturing CD with over 75% avoiding surgery by one year and 8% complications. Further data are required to better identify optimal stricture features and dilatation diameter in children.