P4264 - Needle-Knife Stricturotomy (NKSt) for IBD-Related Strictures: A Single-Center Experience

Muhammad Z. Khan, MD¹, Ammad Javaid. Chaudhary, MD¹, Muhammad Shahzil, MD², Ali Jaan, MD³, Abdullah Sohail, MD⁴, Ahila Manivannan, MD¹, Hamza Asif, MD⁵, Abdulmalik Saleem, MD¹, Muhammad Saad Faisal, MD¹, Syed Ahmad Adil, MD¹, Spandana Alluri, MS, MD⁶, Muhammad Salman Faisal, MD¹, Jason Schairer, MD^1
1Henry Ford Health, Detroit, MI; ²Penn State Health Milton S. Hershey Medical Center, Hershey, PA; ³Rochester General Hospital, Rochester, NY; ⁴University of Iowa Hospitals & Clinics, Iowa City, IA; ⁵Khyber Teaching Hospital, Peshawar, North-West Frontier, Pakistan; ⁶Henry Ford Health, West Bloomfield, MI

Introduction: In recent years, various endoscopic treatment options have emerged for managing strictures associated with inflammatory bowel disease (IBD) and non-IBD conditions. Among these, needle knife stricturotomy (NKSt) has gained attention as a novel approach. By avoiding or delaying surgery, NKSt offers a potential alternative for patients with fibrotic strictures. In this study, we delve into our tertiary care centre’s experience with NKSt, exploring its efficacy and role in treating strictures.

Methods: A retrospective chart review was performed on patients with Crohn’s disease who underwent NKSt at our tertiary care center between 2018 to 2023. Retrospective demographic, clinical, and procedure-specific information was extracted from the electronic medical record. Patients with strictures related to a disease other than IBD were excluded from the study.

Results: In this study involving 48 patients, 30 (62.5%) had anastomotic strictures (AS), while 18 (37.5%) exhibited non-anastomotic strictures (NAS). Demographically, both populations were comparable across all variables assessed. Treatment approaches varied; anti-TNF agents were predominantly used in the AS cohort. (Table 1) At the time of NKSt, steroids were being used by 4 (22.2%) NAS patients and 7 (23.3) AS patients. Abdominal pain was the chief symptom for both groups (NAS: 61%; AS 56.7%) The colon was identified as the most frequent stricture location in both subgroups (AS: 33.3%, NAS: 27.7%). Non-anastomotic strictures had a marginally greater mean length (1.58 ± 0.36 cm) compared to AS (0.9 ± 0.5 cm). In addition to the NSKt, balloon dilatation was performed concurrently on 5 NAS patients (28%) and 6 AS patients (20%). No peri-procedural complication was observed in either group. (Table 2) Symptom recurrence was observed in 22% of NAS cases and 23% of AS cases post-procedure. Subsequent endoscopic intervention was necessary for half of the participants; however, surgical intervention was not required for any patient within either group.

Discussion: In recent times endoscopic stricturotomy has emerged as a safe and effective way of treating AS, and non-AS. The rates of complications in our study were low and the patients had an uneventful procedural course. Previous case series have demonstrated the efficacy of this intervention in strictures < 3 cm such as in our study. With a small sample size being a limitation of this study, we aim to gather more data to increase generalizability and compare NKSt with other endoscopic methods.







Disclosures:


Muhammad Z. Khan, MD¹, Ammad Javaid. Chaudhary, MD¹, Muhammad Shahzil, MD², Ali Jaan, MD³, Abdullah Sohail, MD⁴, Ahila Manivannan, MD¹, Hamza Asif, MD⁵, Abdulmalik Saleem, MD¹, Muhammad Saad Faisal, MD¹, Syed Ahmad Adil, MD¹, Spandana Alluri, MS, MD⁶, Muhammad Salman Faisal, MD¹, Jason Schairer, MD¹. P4264 - Needle-Knife Stricturotomy (NKSt) for IBD-Related Strictures: A Single-Center Experience, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.