Abstract
Background
Small bowel Crohn’s disease (CD) stricture severity is evaluated by magnetic resonance enterography (MRE), computed tomography enterography (CTE) or intestinal ultrasound (IUS) with comparable accuracy. Prestenotic dilatation (PSD) size on MRE and CTE is associated with increased surgical risk. No recent studies have evaluated the impact of PSD size in small bowel CD strictures on IUS and long-term outcomes.
Aims
To describe the proportion of patients with small bowel CD strictures on index IUS and subsequent CD-related hospitalization or surgery.
Methods
Retrospective chart review from a single tertiary center was undertaken to identify patients with small bowel CD strictures and first evidence of PSD documented on IUS. Patients were excluded if PSD was identified on MRE/CTE prior to index IUS. Unpaired t-test with Welch’s correction and Fisher’s exact test assessed continuous and categorical variables, respectively.
Results
79 CD patients with PSD on index IUS (2014-2025) with 4.8 years of median follow up (1-17.5) were identified. Of these, 57.0% (n = 45) had naïve and 43.0% (n = 34) had anastomotic strictures. Mean CD duration at PSD detection was 12 years (0-55). Median BWT was 7.0 mm (3-12), lumen size 2.0 mm (0.7 – 5), PSD size 2.5cm (1.4-8.0) and stricture length 10.0cm (2-50).
From PSD detection, 46.8% (37) required stricture surgery within median of 13 months (0-115) and 26.5% (21) needed hospitalization for CD within median of 7 months (0-86). Larger PSD size (mean 3.0 cm vs 2.4 cm; p = 0.01) predicted need for surgery (p = 0.01) but not hospitalization, while corticosteroid use was associated with both (p = 0.04).
A298 Table 1:
Outcomes
| OUTCOMES | n (%) |
|---|---|
| CD Hospitalisation | 21(27%) |
| Median time from PSD diagnosis on IUS to hospitalisation (m) | 7 (0-86) |
| CD surgery | 37 (47%) |
| Median time from PSD diagnosis on IUS to surgery (m) | 13 (0-115) |
| Steroid use | 37 (47%) |
| Endoscopic balloon dilatation | 11 (14%) |
Conclusions
Nearly 50% of patients with small bowel CD strictures and PSD needed surgery within median 13 months. PSD size and steroid use predicted progression, indicating IUS can aid in prognosis and therapy timing
Funding Agencies
None