Association between mucosal healing and surgery risk after endoscopic balloon dilatation for small intestinal stricture of Crohn’s disease

Background: Small bowel stricture is a major indication for surgery in Crohn’s disease(CD). Balloon-assisted endoscopy has enabled endoscopic balloon dilatation(EBD) for small bowel strictures to avoid surgery. Few studies have analyzed the association between mucosal healing and prognosis of EBD. This study aimed to examine the impact of mucosal healing on prognosis of EBD for small bowel stricture.
Methods: We conducted a single-center, retrospective cohort study of CD patients who underwent EBD for small bowel stricture between 2012 and 2020. EBD was performed for stricture that could not be passed by endoscope. Cases of ileocolonic anastomotic stricture or re-dilation were excluded. We focused on the ulceration of stricture as an indicator of mucosal healing. The association between the ulceration of the stricture and surgery was examined by Cox proportional hazards model.
Results: We evaluated 98 patients, 63 (64%) had ulceration and 35 (46%) did not have ulceration in the stricture. Surgery was performed in 43 patients with ulcer (68%) and 4 patients without ulcer (11%). In multivariable analysis, the risk of surgery were higher in the patients with ulcer than patients without ulcer (hazard ratio: 3.78, 95% confidence interval: 1.16-12.27).
Conclusion: Patients with ulcerated stricture had higher risk of surgery than patients without ulcerated stricture. Achievement of mucosal healing is important for avoiding surgery after EBD.