Bevan Roisin, Rees Colin J, Rutter Matthew D, Macafee David A L
Northern Region Endoscopy Group, UK.
Department of Gastroenterology, South Tyneside District General Hospital, South Shields, UK.
Frontline Gastroenterol. 2013 Oct;4(4):238-243. doi: 10.1136/flgastro-2012-100297. Epub 2013 Mar 27.
Most patients with Crohn's disease present with either terminal ileal or colonic disease, with 70% requiring surgery by 10 years after diagnosis. Recurrent stricturing at the anastomotic site is common, often symptomatic and can require re-operation with its inherent risks. Balloon dilation has been shown to provide good symptom relief from such strictures. However, repeat dilations may be required, and further surgical intervention to an anastomotic stricture is needed in up to 30% of cases. Injection of corticosteroids has been suggested as an adjunct to dilation in order to improve outcomes. This paper reviews the current literature on the use of intralesional steroid injections following endoscopic balloon dilation of anastomotic and de novo Crohn's strictures. There have been only two randomised placebo controlled trials and five small non-controlled or retrospective studies. Study numbers vary from 10 to 29 patients. The two randomised trials conflict in their conclusions and numbers are small in these studies. Currently therefore, no firm support can be given to the routine use of intralesional steroid injections.
大多数克罗恩病患者表现为回肠末端或结肠疾病，70%的患者在确诊后10年内需要手术治疗。吻合口部位反复狭窄很常见，通常有症状，可能需要再次手术，而再次手术存在固有风险。球囊扩张已被证明能有效缓解此类狭窄引起的症状。然而，可能需要重复扩张，高达30%的病例需要对吻合口狭窄进行进一步的手术干预。有人建议注射皮质类固醇作为扩张的辅助手段，以改善治疗效果。本文综述了目前关于内镜下球囊扩张吻合口及新发克罗恩狭窄后病灶内注射类固醇的文献。仅有两项随机安慰剂对照试验以及五项小型非对照或回顾性研究。研究对象数量从10至29名患者不等。这两项随机试验的结论相互矛盾，且这些研究中的样本量较小。因此，目前无法有力支持病灶内注射类固醇的常规使用。
