Greener Tomer, Shapiro Ron, Klang Eyal, Rozendorn Noa, Eliakim Rami, Ben-Horin Shomron, Amitai Marianne M, Kopylov Uri
1 Department of Gastroenterology, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 2 Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dis Colon Rectum. 2015 Dec;58(12):1151-7. doi: 10.1097/DCR.0000000000000491.
Endoscopic balloon dilation and surgery are commonly practiced in stricturing Crohn's disease. Nonetheless, there are still scant data directly comparing these 2 strategies.
The aim of this study was to compare the short- and long-term outcomes of endoscopic balloon dilation versus surgical resection in symptomatic Crohn's strictures.
This was a retrospective cohort study.
The study was conducted at a single tertiary center.
Seventy-nine patients were identified, 40 in the surgical group and 39 in the endoscopic balloon dilation group (mean age 42.8 ± 13.9 versus 38.5 ± 12.2 years).
The outcomes of all patients referred for endoscopic balloon dilation were compared with patients referred to surgery because of stricturing disease between the years 2006 and 2013. The primary outcome was the need for reintervention (either endoscopic balloon dilation or surgery) for symptomatic Crohn's disease during follow-up.
The proportion of patients who required any reintervention during follow-up was significantly lower in the surgical group versus the endoscopic balloon dilation group (OR = 5.62 (95% CI, 1.66-19.01); p = 0.005). The need for surgery/resurgery during follow-up was also significantly lower in the surgically treated group (OR = 3.53 (95% CI, 1.01-12.29); p = 0.047). Reintervention-free survival and surgery-free survival were both significantly shorter in the endoscopically treated group in a Kaplan-Mayer analysis. The rate of major complications was similar in the endoscopically and surgically treated groups (7.6% versus 7.5%; p = 0.7).
The small cohort and the retrospective data collection were limitations of this study.
In our cohort of patients with fibrostenotic Crohn's disease, a direct comparison showed reduced need for reinterventions with a similar rate of immediate major complications after surgery compared with endoscopic balloon dilation.
内镜下球囊扩张术和手术是治疗克罗恩病狭窄的常用方法。然而，直接比较这两种治疗策略的数据仍然很少。
本研究旨在比较内镜下球囊扩张术与手术切除治疗有症状的克罗恩病狭窄的短期和长期疗效。
这是一项回顾性队列研究。
该研究在一家三级中心进行。
共纳入79例患者，手术组40例，内镜下球囊扩张组39例（平均年龄分别为42.8±13.9岁和38.5±12.2岁）。
比较2006年至2013年间因狭窄性疾病接受内镜下球囊扩张术的所有患者与接受手术治疗的患者的疗效。主要结局是随访期间因有症状的克罗恩病需要再次干预（内镜下球囊扩张术或手术）。
随访期间需要再次干预的患者比例，手术组显著低于内镜下球囊扩张组（OR = 5.62（95%CI，1.66 - 19.01）；p = 0.005）。手术治疗组随访期间再次手术的需求也显著更低（OR = 3.53（95%CI，1.01 - 12.29）；p = 0.047）。在Kaplan - Mayer分析中，内镜治疗组的无再次干预生存期和无手术生存期均显著更短。内镜治疗组和手术治疗组的严重并发症发生率相似（7.6%对7.5%；p = 0.7）。
本研究的局限性在于队列规模小和回顾性数据收集。
在我们的纤维狭窄型克罗恩病患者队列中，直接比较显示与内镜下球囊扩张术相比，手术治疗后再次干预需求减少，且近期严重并发症发生率相似。
