P4370 - Outcomes of Needle Knife Stricturotomy (NKSt) and NKSt With Balloon Dilation (NKSt-BD) in Patients With IBD Strictures: A Single Center Experience

Ammad Javaid. Chaudhary, MD¹, Muhammad Z. Khan, MD¹, Ali Jaan, MD², Abdullah Sohail, MD³, Diana Jomaa, MD¹, Muhammad Shahzil, MD⁴, Ahila Manivannan, MD¹, Hamza Asif, MD⁵, Abdulmalik Saleem, MD¹, Muhammad Saad Faisal, MD¹, Taher Jamali, MD⁶, Muhammad Salman Faisal, MD¹, Jason Schairer, MD^1
1Henry Ford Health, Detroit, MI; ²Rochester General Hospital, Rochester, NY; ³University of Iowa Hospitals & Clinics, Iowa City, IA; ⁴Penn State Health Milton S. Hershey Medical Center, Hershey, PA; ⁵Khyber Teaching Hospital, Peshawar, North-West Frontier, Pakistan; ⁶Henry Ford Hospital, Detroit, MI

Introduction: In recent years, endoscopic balloon dilatation (BD), and needle knife stricturotomy have emerged as safe and effective options for managing strictures associated with inflammatory bowel disease (IBD). These bowel sparing techniques, individually, have gained popularity and served as an alternative to surgical interventions. In this study, we delve into our tertiary care center’s experience with using these techniques simultaneously, to treat IBD related strictures.

Methods: A retrospective chart review was performed on patients with Crohn’s disease that underwent NKSt alone and NSKt with BD at our tertiary care center between 2018 to 2023. Retrospective demographic, clinical, and procedure-specific information was extracted from the electronic medical record. Patients with strictures related to a disease other than IBD were excluded from the study. All analyses were performed using SAS 9.4 (SAS Institute Inc., Cary, NC).

Results: In this study involving 50 patients with IBD related fibrotic strictures, 39 (78%) patients underwent NKSt intervention, while 11 (22%) underwent simultaneous NKSt with balloon dilation (NKSt-BD). Patients who underwent NKSt-BD were younger (43.0 ± 10.9 vs 51.2 ± 15.8) and predominantly male (72.7%). (Table 1) NKSt alone was the most common intervention in IBD patients with anastomotic strictures (61.5%) while NKSt-BD was used in 6 patients with anastomotic strictures and 5 patients with non-anastomotic strictures. NKSt-BD was used mostly for longer strictures (2.7± 1.3 cm) and NKSt without BD was used for relatively shorter strictures (1.2 ± 1 cm). Bleeding was the most common peri-procedural complication (7.7%) followed by abdominal pain (2.5%) in NKSt group. No complications were observed in the NKSt-BD group. Only 4 patients in the NKSt group developed complications within 10 days of procedure.(Table 2) Symptoms recurred in 9 (23%) patients in NKSt group and 2 (18.1%) patients who underwent NKSt-BD. 15 (38.4%) patients in NKSt group and 7 (63.6%) patients in NKSt-BD had to undergo repeat endoscopy; one patient in the NKSt group underwent surgery.

Discussion: Our study demonstrates the clinical and technical success of using NSKt in conjunction with BD compared to NSKt alone. The NSKt-BD group was effective and safer in longer fibrotic strictures, however statistical significance was not achieved likely due to the sample size. More multi-centre studies with larger population size need to be conducted to improve generalizability.



Disclosures:


Ammad Javaid. Chaudhary, MD¹, Muhammad Z. Khan, MD¹, Ali Jaan, MD², Abdullah Sohail, MD³, Diana Jomaa, MD¹, Muhammad Shahzil, MD⁴, Ahila Manivannan, MD¹, Hamza Asif, MD⁵, Abdulmalik Saleem, MD¹, Muhammad Saad Faisal, MD¹, Taher Jamali, MD⁶, Muhammad Salman Faisal, MD¹, Jason Schairer, MD¹. P4370 - Outcomes of Needle Knife Stricturotomy (NKSt) and NKSt With Balloon Dilation (NKSt-BD) in Patients With IBD Strictures: A Single Center Experience, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.