Bhalme Mahesh, Sarkar Sanchoy, Lal Simon, Bodger Keith, Baker Rose, Willert Robert P
*Royal Bolton Hospital, Bolton, United Kingdom; †Department of Gastroenterology and Hepatology, Royal Liverpool University Hospitals, Liverpool, United Kingdom; ‡Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom; §Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; ‖Digestive Diseases Centre, Clinical Sciences Centre, Aintree University Hospital, Liverpool, United Kingdom; ¶School of Business, Salford University, Salford, United Kingdom; and **Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom.
Inflamm Bowel Dis. 2014 Feb;20(2):265-70. doi: 10.1097/01.MIB.0000439067.76964.53.
Stricturing is a common complication of Crohn's disease. Endoscopic balloon dilatation (EBD) offers a valuable alternative to surgical intervention, but there are limited data on factors influencing its safety and efficacy.
A multicenter retrospective audit across 4 U.K. teaching hospitals was performed on the use of EBD for Crohn's strictures between 1998 and 2011. Demographics, smoking status, medications, C-reactive protein, endoscopic findings, and subsequent surgery at follow-up were recorded. Success of EBD was defined as symptomatic improvement without the need for surgery at follow-up.
Seventy-nine patients (47 women; median age, 48 yr) were identified for this study. Forty-eight (61%) patients had ileocolonic anastomotic strictures, whereas the rest had de novo strictures. In total, 191 EBDs (range, 1-11; median 2) were carried out on 93 strictures (range, 1-5; median 1) over a median duration of 12 months (range, 1-84). There were no serious adverse events. Success at index EBD was 34%, with a further 43% achieving long-term benefit from additional EBDs. Eighteen (23%) patients required surgery. Time to surgery after the first EDB was 2.6 to 71.1 months (median, 12.8 mo). Longer Crohn's disease duration (P = 0.03) and high C-reactive protein (P = 0.008) were associated with an increased need for subsequent surgery.
EBD was safe and effective in achieving long-term symptom improvement and avoidance of surgery in most patients. Prospective controlled trials are needed to evaluate the effect of other factors, including Crohn's disease phenotype, and the role of concomitant medication to identify those best suited to EBD.
狭窄是克罗恩病的常见并发症。内镜下球囊扩张术（EBD）为手术干预提供了一种有价值的替代方法，但关于影响其安全性和有效性因素的数据有限。
对英国4家教学医院1998年至2011年间使用EBD治疗克罗恩病狭窄的情况进行了多中心回顾性审计。记录了人口统计学资料、吸烟状况、用药情况、C反应蛋白、内镜检查结果以及随访时的后续手术情况。EBD的成功定义为随访时症状改善且无需手术。
本研究共纳入79例患者（47例女性；中位年龄48岁）。48例（61%）患者患有回结肠吻合口狭窄，其余患者为原发性狭窄。总共对93处狭窄（范围1 - 5；中位1处）进行了191次EBD（范围1 - 11；中位2次），中位持续时间为12个月（范围1 - 84个月）。未发生严重不良事件。首次EBD的成功率为34%，另有43%的患者通过额外的EBD获得了长期益处。18例（23%）患者需要手术。首次EBD后至手术的时间为2.6至71.1个月（中位12.8个月）。克罗恩病病程较长（P = 0.03）和C反应蛋白水平较高（P = 0.008）与后续手术需求增加相关。
EBD在大多数患者中安全有效，可实现长期症状改善并避免手术。需要进行前瞻性对照试验来评估其他因素的影响，包括克罗恩病的表型以及联合用药的作用，以确定最适合EBD的患者。
