P2620 - Efficacy and Safety of Endoscopic Balloon Dilatation for Ileal Pouch-Anal Anastomosis Strictures: A Systematic Review And Meta-Analysis

Dushyant S. Dahiya, MD¹, Anuraag Jena, MBBS², Jay Bapaye, MD³, Babu Mohan, MD⁴, Lena Kassab, MD⁵, Antonio Facciorusso, MD, PhD⁶, Saurabh Chandan, MD⁷, Gursimran S. Kochhar, MD^8
1The University of Kansas School of Medicine, Kansas City, KS; ²Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India; ³Virginia Tech Carilion School of Medicine, Roanoke, VA; ⁴Orlando Gastroenterology PA, Orlando, FL; ⁵Mayo Clinic, Rochester, MN; ⁶University of Foggia, Foggia, Puglia, Italy; ⁷CHI Health Creighton University Medical Center, Omaha, NE; ⁸Allegheny General Hospital, Pittsburgh, PA

Introduction: For patients with refractory inflammatory bowel disease (IBD), restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice. In this systematic review and meta-analysis, we assess the efficacy and safety of endoscopic balloon dilatation (EBD) for IPAA strictures.

Methods: A systematic search of numerous databases was performed through December 2023 to identify studies reporting on the outcomes of EBD in pouch-related strictures. Outcomes included technical success, clinical success at index dilation and in pouch retention, recurrence of symptoms post-EBD and adverse events of EBD. Meta-analysis was performed using a random-effects model and results were expressed in terms of pooled rates along with relevant 95% confidence intervals (CI). Heterogeneity was assessed using Cochran Q statistical test with I² statistics.

Results: Seven studies with 504 patients were included. The pooled rate of technical success, defined as the proportion of patients who had successful passage of endoscope post-dilation without resistance, and clinical success, defined as the proportion of patients who had symptomatic improvement without the need for additional dilatation, of index dilatation was 98.9% (95% CI: 94.8-99.8%; I²0%) and 30.2% (95% CI: 7.1-71%; I²0%), respectively.





The pooled rate of clinical success in pouch retention without the need for additional surgery (pouch excision or redo pouch) was 81.4% (95% CI: 69.6-89.3%; I²72%). The pooled failure rate of EBD, defined as the proportion of patients who had permanent pouch diversion, failure of pouch retention, and/or the need for additional surgical intervention (pouch excision or redo pouch) was 18.6% (95% CI: 10.7-30.4%, I²72%).



The pooled rate of recurrence of symptoms after index dilatation was 58.9% (95% CI: 33.3-80.5%; I²13%). The pooled rate of serious adverse events was 1.8% (95% CI: 1-3.5%, I²0%). No deaths related to EBD were reported. Figure 1 demonstrates outcomes and safety of EBD for IPAA strictures.

Discussion: EBD is safe and highly effective for management of IPAA strictures. Additional studies are needed to compare its efficacy with surgical interventions.



Disclosures:


Dushyant S. Dahiya, MD¹, Anuraag Jena, MBBS², Jay Bapaye, MD³, Babu Mohan, MD⁴, Lena Kassab, MD⁵, Antonio Facciorusso, MD, PhD⁶, Saurabh Chandan, MD⁷, Gursimran S. Kochhar, MD⁸. P2620 - Efficacy and Safety of Endoscopic Balloon Dilatation for Ileal Pouch-Anal Anastomosis Strictures: A Systematic Review And Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.