Poster Session II - A299 LONG TERM OUTCOMES IN SMALL BOWEL CROHN’S DISEASE STRICTURES WITH PRE-STENOTIC DILATION ON INTESTINAL ULTRASOUND

TL;DR

This study finds that nearly half of Crohn’s disease patients with small bowel strictures and pre-stenotic dilation on intestinal ultrasound need surgery within a year, with dilation size and steroid use predicting outcomes.

Contribution

The study is the first to evaluate the impact of pre-stenotic dilation size on intestinal ultrasound in Crohn’s disease strictures and its association with long-term outcomes.

Findings

Nearly 50% of patients with small bowel Crohn’s disease strictures and pre-stenotic dilation required surgery within 13 months.

Larger pre-stenotic dilation size and corticosteroid use predicted the need for surgery.

Intestinal ultrasound can help predict disease progression and guide treatment timing.

Abstract

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.

To describe the proportion of patients with small bowel CD strictures on index IUS and subsequent CD-related hospitalization or surgery.

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.

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).

Outcomes

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

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