The Interventional IBD Unit, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Gastrointest Endosc. 2018 Jul;88(1):87-94. doi: 10.1016/j.gie.2018.02.034. Epub 2018 Mar 6.
Fistulas in patients with inflammatory bowel disease (IBD) pose a key challenge in the management of these patients. We aimed to describe a novel endoscopic method to treat patients with IBD who have fistulas.
A cohort of 29 consecutive patients with fistulas and IBD were identified in the registry of our interventional IBD unit. An endoscopic fistulotomy with needle-knife was performed. The primary outcome was healing of the fistula without the need for surgical intervention.
A total of 29 patients underwent endoscopic fistulotomy; and the mean (± standard deviation) age of patients undergoing the procedure was 44.2 ± 14.6 years. Thirteen patients were male (44.8%), and 16 were female (55.2%). Twenty-six patients (89.6%) achieved complete resolution of the fistula as confirmed by endoscopy with a guidewire and/or cross-sectional abdominal imaging, with 10 patients (34.4%) requiring a single endoscopic treatment session. Three patients (10.3%) had a persistent fistula and required surgical intervention. One patient had postoperative bleeding requiring blood transfusion and hospitalization.
Endoscopic fistulotomy with a needle-knife appears to be safe and effective in treating IBD-related fistulas.
炎症性肠病（IBD）患者的瘘管是此类患者治疗中的一个关键挑战。本研究旨在描述一种治疗 IBD 合并瘘管患者的新型内镜方法。
在我们的介入性 IBD 治疗中心的登记处中，我们确定了 29 例患有瘘管和 IBD 的连续患者。采用针刀内镜下切开术进行治疗。主要结局是瘘管无需手术干预而愈合。
共 29 例患者接受了内镜下切开术，患者的平均（±标准差）年龄为 44.2±14.6 岁。男性 13 例（44.8%），女性 16 例（55.2%）。26 例（89.6%）经内镜下导丝和/或横断面腹部影像学检查证实瘘管完全愈合，其中 10 例（34.4%）仅需单次内镜治疗。3 例（10.3%）患者瘘管持续存在，需要手术干预。1 例患者术后出血，需要输血和住院治疗。
针刀内镜下切开术治疗 IBD 相关瘘管似乎安全且有效。
