Lan Nan, Shen Bo
Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio.
Inflamm Bowel Dis. 2017 Apr;23(4):502-513. doi: 10.1097/MIB.0000000000001044.
Fibrotic strictures in patients with inflammatory bowel disease (IBD) are often not amenable to medical therapy. Therapy with endoscopic balloon dilation usually requires frequent repeat treatments. Therefore, we developed the novel needle knife stricturotomy (NKSt) for the treatment of strictures in the patients with IBD. The aim of this study was to evaluate the efficacy and safety of NKSt.
Data of patients with strictures treated with NKSt in our Interventional IBD Unit at the Cleveland Clinic were extracted from the registry. The primary and secondary outcomes were surgery-free survival and procedure-related complications.
A total of 85 patients were included in this study. Multiple strictures were noticed in 30 (35.3%) patients at inception, giving a total of 127 strictures treated. The median length of the treated strictures was 1.5 cm (interquartile range: 1.0-2.0) and 52 (41.6%) were endoscopically nontraversable. The immediate success with passage of the scope through the stricture after NKSt therapy was achieved in all patients. During the median follow-up of 0.9 years (interquartile range: 0.3-1.8) and a median of 2.0 treatment (interquartile range: 1.0-3.0), 13 (15.3%) patients required stricture-related surgery. There were 77 (60.6%) patients who required additional NKSt, endoscopic balloon dilation, or both after the inception of NKSt. In a total of 272 NKSt procedures performed, 10 (3.7%) adverse events occurred, including 9 with delayed bleeding and one hospitalization due to perforation.
Endoscopic NKSt is effective and safe for treating the primary and secondary IBD-related strictures, which may provide an alternative for endoscopic balloon dilation and surgical intervention.
炎症性肠病（IBD）患者的纤维化狭窄通常对药物治疗无效。内镜球囊扩张治疗通常需要频繁重复治疗。因此，我们开发了新型针刀狭窄切开术（NKSt）用于治疗IBD患者的狭窄。本研究的目的是评估NKSt的疗效和安全性。
从克利夫兰诊所介入性IBD病房接受NKSt治疗的狭窄患者的数据中提取资料。主要和次要结局分别为无手术生存期和与手术相关的并发症。
本研究共纳入85例患者。30例（35.3%）患者初诊时发现多处狭窄，共治疗127处狭窄。治疗的狭窄的中位长度为1.5cm（四分位间距：1.0 - 2.0），52处（41.6%）在内镜下无法通过。所有患者在NKSt治疗后内镜均立即成功通过狭窄部位。在中位随访0.9年（四分位间距：0.3 - 1.8）和中位2.0次治疗（四分位间距：1.0 - 3.0）期间，13例（15.3%）患者需要进行与狭窄相关的手术。77例（60.6%）患者在开始NKSt治疗后需要额外的NKSt、内镜球囊扩张或两者皆需。在总共进行的272例NKSt手术中，发生了10例（3.7%）不良事件，包括9例延迟出血和1例因穿孔住院。
内镜下NKSt治疗原发性和继发性IBD相关狭窄有效且安全，可为内镜球囊扩张和手术干预提供替代方案。
