Departments of Gastroenterology and Colorectal Surgery, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Inflamm Bowel Dis. 2011 Dec;17(12):2527-35. doi: 10.1002/ibd.21644. Epub 2011 Feb 23.
Endoscopic management of ileal pouch strictures has not been systemically studied. The aim was to evaluate endoscopic balloon therapy of pouch strictures in inflammatory bowel disease (IBD) patients with ileal pouches and to identify risk factors for pouch failure for those patients.
Consecutive IBD patients with pouches from the Pouchitis Clinic who underwent nonfluoroscopy-guided outpatient endoscopic therapy were studied. The location, number, degree (range 0-3), and length of strictures and balloon size were documented. Efficacy and safety were evaluated with univariate and multivariate analyses.
A total of 150 patients with pouch strictures were studied. Stricture locations were at the pouch inlet (n = 96), outlet (n = 73), afferent limb (n = 33), and pouch body (n = 2). A cumulative of 646 strictures were endoscopically dilated, with a total of 406 pouchoscopies. The median stricture score was 1 (interquartile range [IQR] 1-2); the median stricture length was 1 (IQR 0.5-1.25) cm, and the median balloon size was 20 (IQR 18-20) mm. Of 406 therapeutic endoscopies performed, there were two perforations (0.46%) and four transfusion-required bleeding (0.98%). The 5-, 10-, and 25-year pouch retention rates were 97%, 90.6%, and 85.9%, respectively. In a median follow-up of 9.6 (IQR 6-17) years, 131 patients (87.3%) were able to retain their pouches. The number of strictures and underlying diagnosis were independent risk factors for pouch failure in the Cox regression model.
Endoscopic treatment of pouch stricture appears to be efficacious and generally safe to perform in experienced hands. Underlying diagnosis of Crohn's disease of the pouch and surgery-related strictures and multiple strictures were the risk factors for pouch failure.
回肠贮袋狭窄的内镜治疗尚未得到系统研究。本研究旨在评估内镜下球囊扩张治疗炎症性肠病（IBD）患者回肠贮袋狭窄的效果，并确定影响贮袋功能失败的相关因素。
连续纳入在我院 Pouchitis 门诊接受非透视引导下门诊内镜治疗的 IBD 患者。记录贮袋狭窄的位置、数量、严重程度（0-3 级）、长度和球囊大小。通过单因素和多因素分析评估疗效和安全性。
共纳入 150 例回肠贮袋狭窄患者，贮袋入口狭窄 96 例，出口狭窄 73 例，输入襻狭窄 33 例，贮袋体狭窄 2 例。共内镜扩张狭窄 646 次，行 406 次贮袋内镜检查。狭窄严重程度中位数为 1 级（四分位距[IQR] 1-2 级），狭窄长度中位数为 1cm（IQR 0.5-1.25cm），球囊大小中位数为 20mm（IQR 18-20mm）。406 次治疗性内镜检查中，2 例（0.46%）发生穿孔，4 例（0.98%）需要输血治疗。5、10、25 年的贮袋保留率分别为 97%、90.6%和 85.9%。中位随访 9.6（IQR 6-17）年后，131 例（87.3%）患者的贮袋仍保留。Cox 回归模型显示狭窄数量和基础诊断是贮袋功能失败的独立危险因素。
内镜治疗贮袋狭窄在经验丰富的医生手中具有较好的疗效，且通常较为安全。基础诊断为 Crohn 病、手术相关狭窄和多发狭窄是贮袋功能失败的危险因素。
