Crohns_Disease_Presentation_Elaborate.pptx

CROHN

1. Enteroscopic Balloon Dilation in Crohn’s Disease Long‐Term Outcomes and Risk Factors for Surgery United European Gastroenterology Journal

2. Abstract UnitedEuropean Gastroenterology Journal -ORIGINAL ARTICLE OPEN ACCESS Enteroscopic Balloon Dilation inSmall Bowel Stricturing Crohn’s Disease: Long‐Term Outcomes andRisk Factors forSurgery inaSingle‐Center Prospective Observational Study Sung Noh Hong |JiEunKim |EunRanKim |Dong Kyung Chang |Young‐Ho Kim Department ofMedicine, Samsung Medical Center, Sungkyunkwan University School ofMedicine, Seoul, Korea Correspondence: Sung Noh Hong ([email protected] ;[email protected] ) Received: 22October 2024 |Revised: 22December 2024 |Accepted: 30December 2024

3. Conclusion Author Contributions Sung NohHong: study concept anddesign, data acquisition, analysis, andinterpretation, anddrafting ofthemanuscript. JiEunKim, Eun RanKim, Dong Kyung Chang: data acquisition, data interpretation, andstudy supervision. Young‐Ho Kim: study concept anddesign, data interpretation, andstudy supervision. Conflicts ofInterest Theauthors declare noconflicts ofinterest. Data Availability Statement Thedatasets generated and/or analyzed inthecurrent study arenot publicly available prior topublication, butareavailable onreasonable request from thecorresponding author ([email protected] ).

4. Background Crohn’s disease (CD): Chronic inflammatory bowel disease affecting GI tract. Complication: Development of intestinal strictures → significant morbidity. Traditionally managed with surgery. Endoscopic Balloon Dilation (EBD): Minimally invasive alternative using balloon-assisted enteroscopy (BAE).

5. Study Aim Evaluate long-term outcomes of EBD in small bowel strictures in Crohn’s disease. Assess cumulative surgery-free rate. Identify risk factors for subsequent surgery after EBD.

6. Methods – Study Design Prospective, longitudinal, observational study. Conducted at Samsung Medical Center, Seoul, Korea. Patients enrolled: May 2018 – April 2023. Follow-up through April 2024.

7. Methods – Patient Selection Inclusion: Adults (18–75 years) with Crohn’s disease and at least one small bowel stricture. Exclusion: Strictures >4 cm, associated with abscess/fistula/malignancy, or high procedural risk. Total analyzed: 150 patients (235 procedures).

8. Results – Patient Demographics 150 patients analyzed (mean follow-up 42.4 months). Index strictures: 18% web-like, 52% ulcerated, 30% spindle-shaped. 36% had ≥2 strictures treated. Predominantly male population (82.7%).

9. Results – Short-Term Outcomes Technical success: 78.7% overall. By morphology: Web-like (95.7%), Ulcerated (88.1%), Spindle-shaped (40.7%). Clinical success (symptom relief): 87.3%.

10. Results – Long-Term Outcomes 20.7% of patients required surgery after EBD. Cumulative surgery-free survival: - 1 year: 86.7% - 3 years: 80.4% - 5 years: 76.6% Morphology mattered: Web-like had best outcomes, spindle-shaped worst.

11. Results – Re-dilation 47.1% required repeat dilation during follow-up. Cumulative re-dilation-free survival: - 1 year: 75.5% - 3 years: 54.3% - 5 years: 47.2% Web-like strictures had lowest re-dilation rate.

12. Risk Factors for Surgery Spindle-shaped strictures: 13x higher risk vs. web-like. Ulcerated strictures: 8.5x higher risk vs. web-like. Conventional therapy only (vs. biologics): 2.5x higher risk. Biologics beneficial in ulcerated strictures post-EBD.

13. Safety Major complication rate: - Per patient: 2.7% - Per procedure: 1.7% Complications: perforation (2), bleeding (1), fever (1). Overall, EBD is safe with low complication rate.

14. Discussion EBD is an effective and safe alternative to surgery in Crohn’s small bowel strictures. Outcomes strongly influenced by stricture morphology. Biologic therapy enhances long-term outcomes, particularly in ulcerated strictures. Spindle-shaped strictures may warrant early surgical consideration.

15. Conclusion EBD provides durable outcomes for web-like and ulcerated strictures. Spindle-shaped strictures show poor outcomes and higher surgery risk. Biologics post-EBD improve surgery-free survival in ulcerated strictures. Tailored management strategy recommended.