Jain Deepanshu, Sandhu Naemat, Singhal Shashideep
Division of Gastroenterology, Department of Internal Medicine (Deepanshu Jain), USA.
Department of Internal Medicine (Naemat Sandhu), Albert Einstein Medical Center, Philadelphia, PA.
Ann Gastroenterol. 2017;30(5):473-485. doi: 10.20524/aog.2017.0163. Epub 2017 May 30.
Benign anastomotic strictures can occur in up to 22% of patients who undergo colonic or rectal resection. Traditionally, surgery was the preferred method of treatment, but, over time, endoscopic techniques, such as balloon dilation, have become the preferred modality. However, a high stricture recurrence rate of up to 18-20% and the increased risk of perforation due to uncontrolled stretching are its major drawbacks. Endoscopic electrocautery incision (EECI) allows for controlled mucosal incision in predetermined locations of stricture. In this meta-analysis, we have summarized case reports, case series, retrospective studies and prospective studies describing the different endoscopic EECI techniques used for benign lower gastrointestinal tract anastomotic strictures. Our analysis showed that EECI, either alone or in combination with other modalities (e.g. balloon dilation, steroid injection or argon plasma coagulation) is an effective treatment option for both treatment-naïve and refractory short non-inflammatory strictures. The overall success rate for EECI-based therapy for benign colorectal stricture was 98.4%, with a stricture recurrence rate of 6.0%. No major adverse event (bleeding, infection or perforation) was reported. Only minor adverse events (abdominal pain) were reported in 3.8% of the population.
良性吻合口狭窄在接受结肠或直肠切除的患者中发生率高达22%。传统上，手术是首选的治疗方法，但随着时间的推移，诸如球囊扩张等内镜技术已成为首选方式。然而，高达18 - 20%的高狭窄复发率以及因不受控制的扩张导致的穿孔风险增加是其主要缺点。内镜电灼切开术（EECI）可在狭窄的预定位置进行可控的黏膜切开。在这项荟萃分析中，我们总结了描述用于良性下消化道吻合口狭窄的不同内镜EECI技术的病例报告、病例系列、回顾性研究和前瞻性研究。我们的分析表明，EECI单独使用或与其他方式（如球囊扩张、类固醇注射或氩等离子体凝固）联合使用，对于初治和难治性短非炎性狭窄都是一种有效的治疗选择。基于EECI治疗良性结直肠狭窄的总体成功率为98.4%，狭窄复发率为6.0%。未报告重大不良事件（出血、感染或穿孔）。仅3.8%的人群报告了轻微不良事件（腹痛）。
