Mo1898 Continuation or Switch to Another Anti-TNFα After Intestinal Resection in Crohn's Disease Patients Previously Exposed to Anti-TNFα?

Background and aims Stricture of small intestine is an important complication of Crohn's disease (CD).It often needs resection of gut and finally causes short bowel syndrome.Development of balloon-assisted enteroscopy (BAE) enables approaching small intestinal lesions.BAE can also perform endoscopic balloon dilatation (EBD) for CD strictures.However, EBD often needs re-dilatation because CD is a chronic inflammatory disease and cause restricture.It is reported that mucosal healing is important for better prognosis.Here we compared the outcomes of EBD for small intestinal stricture with or without ulcer in patients CD.Patients and methods 184 patients with L1 or L3 Crohn's disease were examined by single-balloon enteroscope (Olympus, Tokyo, Japan).74 patients had de novo stricture in the small intestine.Indication of endoscopic balloon dilatation is stricture that was not passes by enteroscope (9.2mm diameter), length was less than 5cm, without fistula or deep ulcer, and without steep bending at the stricture.Through-the-scope balloon catheter (CRE Wire-guided Balloon Dilators, Boston Scientific, Natick, MA) was used for EBD.The balloon dilator was inserted to stricture and inflated under direct vision for 2 minutes.Results EBD was performed for 91 strictures in 60 patients who had den novo stricture in the small intestine.In other 14 patients, EBD were not performed because of deep ulcer (43%), fistula (14%), length of stricture(7%), inflammatory stricture(14%), and steep bending (21%).EBD performed patients consisted of 47 men and 13 women.Mean age was 38.7+-11.4years old (range 20-65 y.o.).Immunomodulator and anti-TNF antibody was used in 38% and 53 % of patients respectively.The overall follow-up period was a mean of 283 days (range, 0-861).The whole re-dilatation-free rate after the initial EBD was 79.9% at 180 day, and 53.9% at 1 year.We compared the re-dilatation-free rate in patients with and without ulcer at stricture.The re-dilatation-free rate of with-ulcer stricture (n=64) and without-ulcer stricture (n=27) were 35.9% and 75.7% at 1 year respectively (P<0.001, log-rank test).94.4% of ulcerated strictures needed re-dilatation or surgery within 420 days after initial EBD.As for adverse events, one perforation occurred in a patient and needed the emergent surgery.The lesion was ulcerated in the terminal ileum.No patients developed pancreatitis.Conclusions The re-dilatation-free interval of ulcerated stricture was significantly shorter than that of stricture without ulcer.Mucosal healing is an important factor of avoiding restricture and better prognosis of EBD for small intestinal stricture by Crohn's disease.