Abstract Background Crohn’s disease (CD) is a chronic inflammatory condition which can affect the entire gastrointestinal tract with a wide variety of potential complications which may require endoscopic or surgical interventions. Small bowel CD beyond the reach of standard endoscopy poses a diagnostic obstacle and relies on cross sectional imaging ─ such as computed tomography enterography (CTE) ─ and balloon assisted endoscopy (BAE). BAE is the current diagnostic gold standard allowing for direct mucosal visualization as well as therapeutic capabilities; however, remains limited by access, cost, and requires specialized training. Alternatively, CTE in small bowel in CD is widely available, and less invasive than BAE. The diagnostic accuracy of CTE against the gold standard of BAE remains unclear. Purpose We aim to assess the sensitivity and specificity of CTE vs BAE in the diagnosis and evaluation of small bowel CD. Method Patients with an established diagnosis of Crohn’s disease who underwent a CTE and a BAE within 6 months between 2011 and 2018 were reviewed. Relevant findings of active inflammation (defined by mural hyperenhancement and thickening), long-segment disease (≥ 15 cm active disease), skip-segments, number of strictures, and presence of high-grade strictures (defined on BAE as inability to traverse with scope prior to dilation and on CTE as prestenotic luminal dilation ≥3cm and fecalization) were extracted from both reports and images of CTE and BAE by two independent reviewers. Sensitivity and specificity for each finding on CTE was calculated using BAE as the gold-standard diagnostic test. Result(s) A total of 42 patients with 65 corresponding CTE and BAE were identified between 2011 and 2018. CTE was found to be most sensitive for assessing presence of active inflammation and number of strictures at 75.6% [95% CI, 60.5-87.1%] and 71.4% [95% CI, 55.4-84.3], respectively. CTE was highly specific for findings of long-segment inflammation, skip lesions, number of strictures, and high-grade stricture with a specificity of 89.3% [95% CI, 78.1-96.0], 74.1% [95%, 67.2-94.7], 100% [97.5% CI, 73.5-100], and 84.4% [95% CI, 67.2-94.7] respectively. CTE showed poor specificity for active inflammation 45.0% [23.1-68.5%], and poor sensitivity for high grade strictures 54.5% [36.4-71.9] and skip lesions 54.5% [23.4-83.3] Image Conclusion(s) CTE is relatively sensitive in detecting active inflammation and number of strictures compared to BAE, but showed suboptimal sensitivity in detecting long segment inflammation, skip lesions, and high-grade strictures. CTE showed high specificity in identification of long segment inflammation, number of strictures, and high-grade strictures, but not active inflammation overall. CTE and BAE are complementary to one another and based utilized in combination to improve diagnostic accuracy. Future directions include prospective validation prospective studies to validate the results of this study looking at a broader population of Crohn’s disease patients. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Stenosen sind eine häufige Komplikation des Morbus Crohn (MC). Im Gegensatz zur kolos kopischen Dilatation von ileozökalen Stenosen ist die publizierte Evidenz zur Dilatation von Dünndarmstenosen mittels Ballon-assistierter Enteroskopie limitiert.

Crohn’s disease (CD) is an inflammatory bowel disease that is characterized by chronic transmural inflammation of the gastrointestinal (GI) tract which can become complicated by the formation of strictures. CD can affect any part of the GI tract with 30–40% of patients having isolated small bowel CD. Complicated CD carries with it significant risk factors for the patient that can often only be alleviated through surgery or medication. However, the advent of Endoscopic Balloon Dilation (EBD) has allowed for temporary relief of obstructive symptoms and could potentially be an alternative therapy that prolongs the need for surgical intervention. This study is conducted to assess the safety and efficacy of EBD in patients with small bowel CD. A retrospective chart review was undertaken to examine all patients with small bowel CD who underwent BAE between July 2013 and August 2017. The data collection included patient demographics, disease characteristics, procedural characteristics, and stricture dilation data. 152 BAEs (84 DBE, 68 SBE) were performed on 82 patients (45 female). The mean age at the time of the BAE was 53.4 ± 15.7 years. The mean disease duration was 17.4 ± 14.0 years. Fifty (61.0%) patients had undergone a previous gastrointestinal surgery. Of the 152 procedures, 84 (55.3%) required EBD, constituting 58.5% (48) of the total patients. In total, 191 strictures were dilated; 75.9% (145) were native strictures, 24.1% (46) were anastomotic strictures. There were a total of 3 (2.0%) complications, and there were no perforations or deaths. Thirty-five procedures (23.1%) involved a non-traversable stricture; in 25 (71.4%) of these procedures, the non-traversable stricture prevented the endoscopist from EBD. Endoscopic Balloon Dilation is a safe and effective intervention for the treatment of small bowel Crohn’s disease and is likely under-utilized as an endoscopic tool. EBD can alleviate obstructive symptoms for both patients who have had previous resections or those with primary stenosis. In some patients, EBD may be effective enough to prolong or prevent the need for surgical resection. Procedural data for patients with small bowel Crohn’s disease undergoing Endoscopic Balloon Dilation Procedural data for patients with small bowel Crohn’s disease undergoing Endoscopic Balloon Dilation CEGIIR (The Center of Excellence for Gastrointestinal Inflammation and Immunity Research)

Immunosuppressive agents have revolutionized the treatment of inflammatory bowel disease (IBD). However, a number of studies over the last decade have identified a concerning link between immunosuppression and lymphoproliferative disorders (LPDs). These LPDs have been associated with Epstein-Barr virus (EBV) infection in which the virus provides the impetus for malignant transformation while immunosuppression hampers the immune system’s ability to detect and clear these malignant cells. There is limited knowledge on LPD risk in individuals with IBD. This study is conducted to determine if immunosuppressive therapy in the IBD population increases the risk of LPDs. This study is divided into two arms: a retrospective and a prospective study. A retrospective chart review was conducted on IBD patients in Alberta from 2005–2015. Alberta Cancer Registry (ACR) and Electronic Medical Records (EMRs) used by the IBD team at the University of Alberta Hospital were searched with keywords “lymphoma” and “IBD”. Patient age, gender, year of IBD diagnosis, year of lymphoma diagnosis, and type of lymphoma data were obtained. An ongoing prospective study has followed patients from the IBD Clinic and the University of Alberta Hospital from 2016 to present. Initial EBV serologies were completed at baseline. Patients are to be followed-up for 3 years to determine if seroconversion and immunosuppression confer increased risk of LPD development. In total, 209 patients have been enrolled in this study; 176 (84.2%) have been screened, while 33 (15.8%) are pending results. Of the 176 screened, 108 (61.4%) are female. Ninety (51.1%) patients are diagnosed with Crohn’s disease, 79 (44.9%) with Ulcerative Colitis, and 7 (4.0%) with Indeterminate Colitis. The EBV serology results showed 9.1% (16) of patients with negative exposure, 72.7% (128) with past exposure, 9.7% (17) with indeterminate IgM, while 1.1% (2) had a positive viral load. Of the 16 patients with negative exposure, 10 (62.5%) were on biologics, 8 (50%) on an immunomodulatory, and 6 (37.5%) were on both. Retrospectively, 14 patients (9 male) had developed lymphoma. Positive EBV histology was found in 3 (21.4%) patients. These interim results suggest that LPD remains a small but possible risk of immunosuppressant use in IBD patients. The utilization of an EBV serologic monitoring protocol may help to identify those at the highest risk of LPD development. Type of immunosuppressant therapy in the seronegative population Type of immunosuppressant therapy in the seronegative population CEGIIR (The Center of Excellence for Gastrointestinal Inflammation and Immunity Research)