Singh Rana Surinder, Kumar Bhasin Deepak, Rao Chalapathi, Singh Kartar
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Ann Gastroenterol. 2013;26(2):141-145.
Benign ileal strictures can cause considerable morbidity and they have been conventionally treated with surgery. The aim of this study was to report our experience of endoscopic balloon dilatation (EBD) in patients with terminal ileal strictures because of Crohn's disease and tuberculosis.
Over the last 8 years, 9 patients (6 males; mean age 39.7±13.2 years) with benign terminal ileal strictures were treated by EBD using a colonoscope and through-the-scope controlled radial expansion balloon dilators.
The etiology of benign ileal stricture was Crohn's disease in 5 and tuberculosis in 4 patients. All the patients with Crohn's disease had no or partial response to 4 weeks of steroid therapy and there were no mucosal ulcerations on ileoscopy. Three patients with ileal strictures due to tuberculosis underwent dilatation after completion of the antitubercular therapy (ATT) while one patient required dilatation 3 months after starting ATT. All patients had single ileal stricture with length of stricture ranging from 0.6-1.8 cm. EBD was successful in all 9 patients with a median number of dilating sessions required of 2 (range: 1-5 sessions). Patients with Crohn's disease required more endoscopic sessions as compared to patients with tuberculosis but this difference was not statistically significant (mean number of session being 3.0±1.58 vs. 1.75±0.5 sessions respectively; P=0.1). One patient with ileal tuberculosis had enterolith proximal to the stricture that could be removed with dormia. There were no complications of the endoscopic procedure.
EBD is an effective, safe, and minimally invasive treatment modality for benign ileal strictures.
良性回肠狭窄可导致相当大的发病率，传统上采用手术治疗。本研究的目的是报告我们对因克罗恩病和结核病导致的回肠末端狭窄患者进行内镜球囊扩张术（EBD）的经验。
在过去8年中，9例（6例男性；平均年龄39.7±13.2岁）良性回肠末端狭窄患者使用结肠镜和经内镜控制的径向扩张球囊扩张器进行了EBD治疗。
良性回肠狭窄的病因是克罗恩病5例，结核病4例。所有克罗恩病患者对4周的类固醇治疗无反应或部分反应，回肠镜检查未见黏膜溃疡。4例因结核病导致回肠狭窄的患者在完成抗结核治疗（ATT）后进行了扩张，1例患者在开始ATT 3个月后需要扩张。所有患者均为单一回肠狭窄，狭窄长度为0.6 - 1.8 cm。9例患者的EBD均成功，所需扩张次数中位数为2次（范围：1 - 5次）。与结核病患者相比，克罗恩病患者需要更多的内镜检查次数，但差异无统计学意义（平均检查次数分别为3.0±1.58次和1.75±0.5次；P = 0.1）。1例回肠结核患者在狭窄近端有肠石，可通过取石篮取出。内镜手术无并发症。
EBD是治疗良性回肠狭窄的一种有效、安全且微创的治疗方式。
