Centre for Colorectal Disease, St. Vincent's University Hospital/University College Dublin, Dublin, Ireland.
J Crohns Colitis. 2013 Jul;7(6):474-80. doi: 10.1016/j.crohns.2012.07.019. Epub 2012 Aug 14.
There is a high rate of stricturing post-operative recurrence in Crohn's disease (CD) particularly at sites of surgical anastomosis, and over 50% of these patients will require a repeat resection. Endoscopic dilatation of anastomotic strictures is an alternative to surgical resection in selected patients. We aimed to evaluate the safety and long term efficacy of endoscopic balloon dilatation of symptomatic anastomotic strictures in CD.
Retrospective analysis of a prospectively maintained inflammatory bowel disease database of patients attending a single academic centre (n=1244 patients with CD) who underwent dilatation.
Fifty-five dilatations were performed in 31 patients (mean age 43 ± SD 12, 47% female). Median follow-up period was 46 months (IQR 14-62). Ninety percent of patients had successful initial dilatation and no complications occurred. Six (21%) avoided further dilatations or surgery in the follow-up period. Stricture recurrence was detected in 22 patients; 15 (54%) patients had repeat dilatations and seven (25%) went straight to surgery. Eight (28%) patients were managed with repeat dilatations of the stricture (median dilatations=2 range 2-6) and seven (25%) required surgery despite repeat dilatations. Median time from first dilatation to repeat surgery was 14.5 months (IQR 3-28) and to repeat dilatation was 13.8 months (IQR 4-28). There was no difference in immunomodulator use, biologic use and smoking status between the groups requiring surgery versus dilatation only.
Endoscopic balloon dilatation of anastomotic strictures is safe and effective in providing symptomatic relief in CD patients. Forty-five percent of patients had a sustained response to single/serial balloon dilatation with avoidance of further surgical resection for a median interval of 46 months. Post-operative medical therapy and smoking status did not predict requirement for recurrent dilatation or surgery.
克罗恩病（CD）患者术后狭窄的复发率很高，特别是在手术吻合部位，超过 50%的患者需要再次手术切除。在选择的患者中，内镜球囊扩张术是吻合口狭窄的一种替代手术治疗方法。本研究旨在评估内镜球囊扩张术治疗 CD 患者症状性吻合口狭窄的安全性和长期疗效。
对单中心前瞻性炎症性肠病数据库中接受扩张治疗的 31 例（31 例患者共进行 55 次扩张）CD 患者进行回顾性分析。
31 例患者（平均年龄 43 ± 12 岁，47%为女性）共进行了 55 次扩张。中位随访时间为 46 个月（IQR 14-62）。90%的患者初次扩张成功，无并发症发生。6 例（21%）在随访期间避免了进一步的扩张或手术。22 例患者发现狭窄复发，15 例（54%）患者再次接受扩张治疗，7 例（25%）患者直接手术。8 例（28%）患者接受了狭窄的再次扩张治疗（中位扩张次数为 2 次，范围 2-6 次），7 例（25%）尽管接受了再次扩张治疗，但仍需手术。首次扩张至再次手术的中位时间为 14.5 个月（IQR 3-28），首次扩张至再次扩张的中位时间为 13.8 个月（IQR 4-28）。需要手术和仅需扩张治疗的患者之间，免疫调节剂使用、生物制剂使用和吸烟状态无差异。
内镜球囊扩张术治疗 CD 患者吻合口狭窄安全有效，可缓解症状。45%的患者在中位随访 46 个月时仅通过单次/多次球囊扩张即可获得持续缓解，避免了进一步的手术切除。术后药物治疗和吸烟状态并不能预测是否需要再次扩张或手术。
