Ferlitsch A, Reinisch W, Püspök A, Dejaco C, Schillinger M, Schöfl R, Pötzi R, Gangl A, Vogelsang H
Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Endoscopy. 2006 May;38(5):483-7. doi: 10.1055/s-2006-924999.
Strictures are a substantial cause of morbidity in patients with Crohn's disease. Endoscopic balloon dilation is a therapeutic option in limited strictures to avoid intestinal surgery, although there have been few reports regarding the long-term outcome.
Balloon dilation was scheduled for 46 patients (26 women, 20 men; median age 34) with Crohn's-associated symptomatic and radiographically confirmed intestinal stenosis. The study plan envisaged up to four consecutive treatments within the first 2 months until relief of symptoms, and thereafter dilations depending on clinical requirements.
Dilation was not possible in seven of the 46 patients (15 %), due to technical problems (n = 2), internal fistulas (n = 3), or absence of a stenosis (n = 2). Thirty-nine patients received at least one treatment. The site of obstruction was the ileocolonic anastomosis in 23 of the 39 patients (59 %) and surgically untreated areas in 16 patients (41 %). After the initial dilation series (median 1, interquartile range 1-2), strictures were traversed in 37 of the 39 patients (95 %). During a median follow-up period of 21 months (range 3-98 months), 24 of the 39 patients (62 %) underwent a repeat intervention, including 12 (31 %) with repeat dilation, 11 (28 %) with surgical resection, and one patient who received an intestinal stent. The cumulative percentages of patients without a repeat intervention or surgery at 6, 12, 24, and 36 months were 68 %, 48 %, 36 %, and 31 %, and 97 %, 91 %, 84 % and 75 %, respectively. Two perforations and one case of severe bleeding were seen in the 73 dilation procedures (4 %) performed.
Endoscopic balloon dilation is a safe and effective method that allows surgery to be avoided in approximately 75 % of patients with Crohn's-associated short intestinal strictures. However, recurrent symptoms frequently make it necessary to repeat the procedure.
狭窄是克罗恩病患者发病的重要原因。内镜下球囊扩张是治疗局限性狭窄以避免肠道手术的一种选择，尽管关于其长期疗效的报道较少。
计划对46例（26例女性，20例男性；中位年龄34岁）患有克罗恩病相关症状且经影像学证实的肠道狭窄患者进行球囊扩张。研究计划设想在最初2个月内最多连续进行4次治疗，直至症状缓解，此后根据临床需要进行扩张。
46例患者中有7例（15%）因技术问题（2例）、内瘘（3例）或无狭窄（2例）无法进行扩张。39例患者接受了至少一次治疗。梗阻部位在39例患者中的23例（59%）为回结肠吻合口，16例患者（41%）为手术未处理区域。在初始扩张系列（中位次数1次，四分位间距1 - 2次）后，39例患者中的37例（95%）狭窄被打通。在中位随访期21个月（范围3 - 98个月）内，39例患者中的24例（62%）接受了再次干预，包括12例（31%）再次扩张、11例（28%）手术切除以及1例接受肠道支架置入的患者。在6个月、12个月、24个月和36个月时未进行再次干预或手术的患者累积百分比分别为68%、48%、36%和31%，以及97%、91%、84%和75%。在进行的73次扩张操作中有2例穿孔和1例严重出血（4%）。
内镜下球囊扩张是一种安全有效的方法，可使约75%的克罗恩病相关短肠狭窄患者避免手术。然而，复发症状常常使得有必要重复该操作。
