Sunada Keijiro, Shinozaki Satoshi, Nagayama Manabu, Yano Tomonori, Takezawa Takahito, Ino Yuji, Sakamoto Hirotsugu, Miura Yoshimasa, Hayashi Yoshikazu, Sato Hiroyuki, Lefor Alan Kawarai, Yamamoto Hironori
*Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan; †Shinozaki Medical Clinic, Tochigi, Japan; and ‡Department of Surgery, Jichi Medical University, Tochigi, Japan.
Inflamm Bowel Dis. 2016 Feb;22(2):380-6. doi: 10.1097/MIB.0000000000000627.
Crohn's disease (CD) strictures of the small intestine are a feared complication and difficult to treat because of difficulty gaining access to the stricture site. The development of double-balloon endoscopy (DBE) enabled access to the entire small intestine with interventional capabilities. The aim of this study was to assess the long-term outcomes in patients with small intestinal strictures secondary to CD after DBE-assisted endoscopic balloon dilation (EBD).
In this retrospective cohort study, DBE-assisted EBD was performed in 85 consecutive patients with CD strictures of the small intestine from 2002 to 2014. Follow-up data were available for 85 patients for a mean of 41.9 months (range, 0-141), and clinical outcomes were assessed.
Overall, 321 DBE-assisted EBD sessions (473 procedures) were performed in 85 patients during the study period. Most CD strictures were de novo (97%). The surgery-free rate after initial DBE-assisted EBD was 87.3% at 1 year and 78.1% at 3 years. The presence of a fistula was significantly associated with the need for surgical intervention (hazard ratio = 5.50, 95% confidence interval: 2.16-14.0, P < 0.01). The surgery-free interval in patients with a fistula was significantly shorter than in patients without a fistula (P < 0.01, log-rank test).
DBE-assisted EBD provides a favorable long-term outcome in patients with small intestinal CD-associated strictures. DBE-assisted EBD for CD strictures is a safe and effective treatment to avoid or postpone surgery over the long-term.
克罗恩病（CD）导致的小肠狭窄是一种可怕的并发症，由于难以接近狭窄部位，治疗困难。双气囊内镜（DBE）的发展使人们能够借助介入能力进入整个小肠。本研究的目的是评估DBE辅助内镜下球囊扩张术（EBD）治疗CD继发小肠狭窄患者的长期疗效。
在这项回顾性队列研究中，2002年至2014年对85例连续性CD小肠狭窄患者进行了DBE辅助EBD。85例患者均有随访数据，平均随访41.9个月（范围0 - 141个月），并评估临床疗效。
在研究期间，85例患者共进行了321次DBE辅助EBD手术（473例操作）。大多数CD狭窄为原发性（97%）。初次DBE辅助EBD术后1年的无手术率为87.3%，3年时为78.1%。存在瘘管与需要手术干预显著相关（风险比=5.50，95%置信区间：2.16 - 14.0，P < 0.01）。有瘘管患者的无手术间隔时间显著短于无瘘管患者（P < 0.01，对数秩检验）。
DBE辅助EBD为CD相关小肠狭窄患者提供了良好的长期疗效。DBE辅助EBD治疗CD狭窄是一种安全有效的治疗方法，可长期避免或推迟手术。
