P0766 STENOLAT: Multicenter Study on the Therapeutic Approach to Intestinal Strictures in Crohńs Disease in Latin America

Abstract

Abstract Background Intestinal strictures represent one of the most frequent and challenging complications of Crohn’s disease (CD). Knowledge regarding optimal therapeutic approaches (medical, endoscopic, or surgical) remains limited and fragmented in Latin America, given the absence of standardised regional guidelines. This multicentre, retrospective-observational study (STENOLAT) was designed to characterise the stricture features in Latin American CD patients and to evaluate the effectiveness and safety of current management modalities in real-world practice. Methods This was a multicentre, retrospective-observational study conducted across Latin American reference centres. Data from 279 patients were analysed. Variables were expressed as median [Interquartile Range (IQR)] or percentage (%). Outcomes were evaluated for medical, endoscopic, and surgical treatments. Key endpoints included technical success, clinical success at 6 months, and complications. Logistical regression models were utilised to identify predictors of clinical success, technical success, and avoidance of surgery. Results The overall cohort had a median age of 49.5 years [IQR: 34.2–65], and the stricturing B2 phenotype was highly prevalent (82.8%). Strictures were primarily Primary (84%), located in the ileum (59%), and classified as Long length (50%). The Inflammatory radiological phenotype was the most common (49%). Clinical effectiveness at 6 months varied significantly: Medical therapy (N = 263), primarily using Anti-tumour necrosis factor (Anti-TNF) agents (38%), achieved success in 73%. Endoscopic treatment (N = 73), mainly balloon dilatation (93%), yielded 80% technical success and 82% clinical success, though 35% required subsequent re-treatment or surgery. Surgical management (N = 102), mainly consisting of resection (94%), demonstrated the highest 6-month clinical success rate (95%). Furthermore, 42% of surgical patients remained symptom-free for ≥25 months. An inflammatory radiological characteristic was identified as a significant negative predictor for technical success (Odds Ratio (OR) 0.16; p < 0.001) and was associated with a lower likelihood of avoiding surgery (OR 0.41; p = 0.026). Complications were reported as 17.8% for endoscopic procedures and 13.7% for surgical interventions. Conclusion Surgical resection provides the highest short-term clinical effectiveness (95%) and offers the most sustained symptom-free periods in the management of stricturing CD in this Latin American cohort. The identification of an inflammatory radiological phenotype is a critical prognostic factor, as it strongly predicts lower technical success and reduces the probability of successfully avoiding surgical intervention. References: 1. Crespi M, Dulbecco P, De Ceglie A, Conio M. Strictures in Crohn’s Disease: From Pathophysiology to Treatment. Dig Dis Sci. 2020 Jul;65(7):1904-1916. doi: 10.1007/s10620-020-06227-0. Epub 2020 Apr 11. PMID: 32279173. 2. Fousekis FS, Mitselos IV, Tepelenis K, Pappas-Gogos G, Katsanos KH, Lianos GD, Frattini F, Vlachos K, Christodoulou DK. Medical, Endoscopic and Surgical Management of Stricturing Crohn’s Disease: Current Clinical Practice. J Clin Med. 2022 Apr 23;11(9):2366. doi: 10.3390/jcm11092366. PMID: 35566492; PMCID: PMC9104530. Conflict of interest: Parra Izquierdo, Leidy Viviana: No conflict of interest Juliao Baños, Fabián: No conflict of interest Osorio, Laura: No conflict of interest Gomez Venegas, Alvaro: No conflict of interest Florez, Cristian: No conflict of interest Barreto Perez, Jonathan: No conflict of interest Andrade Zamora, David Augusto: No conflict of interest Jara Alba, Maria Luisa: No conflict of interest Nuñez, Paulina: No conflict of interest Sandoval, Luis Fernando: No conflict of interest Zanotelli Bombassaro, Isadora: No conflict of interest Reinoso, Aixa: No conflict of interest Goncalves, Silvina: No conflict of interest Paredes Mendez, Juan: No conflict of interest Cedron Cheng, Hugo Guillermo: No conflict of interest Villa, Keyla: No conflict of interest Fraga, Silvana: No conflict of interest Iglesias, Claudio: No conflict of interest Delgado, Laura: No conflict of interest Zurita-Bejarano, Rosario: No conflict of interest Gutierrez, Aura Victoria: No conflict of interest Dr. Frías-Ordoñez, Juan: No conflict of interest Blasco, Carmelo: No conflict of interest Ernest-Suárez, Kenneth: No conflict of interest