Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, QC H3G1A4, Canada.
Division of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium and University of Leuven, Leuven 3000, Belgium.
World J Gastroenterol. 2018 May 7;24(17):1859-1867. doi: 10.3748/wjg.v24.i17.1859.
Symptomatic intestinal strictures develop in more than one third of patients with Crohn's disease (CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures. Treatment options for fibrostenotic strictures are limited to endoscopic and surgical therapy. Endoscopic balloon dilatation (EBD) appears to be a safe, less invasive and effective alternative modality to replace or defer surgery. Serious complications are rare and occur in less than 3% of procedures. For non-complex strictures without adjacent fistulizaation or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. The aim of this review is to present the current literature on the endoscopic management of small bowel and colonic strictures in CD, which includes balloon dilatation, adjuvant techniques of intralesional injection of steroids and anti-tumor necrosis factor, and metal stent insertion. Short and long-term outcomes, complications and safety of EBD will be discussed.
症状性肠道狭窄在发病 10 年内超过三分之一的克罗恩病（CD）患者中发展。狭窄可以是炎症性、纤维性或混合性的，并导致生活质量显著下降，经常需要手术缓解症状。患有肛周疾病且年龄在 40 岁以下的患者更有可能患有致残性回结肠疾病，因此可能有更高的纤维性狭窄风险。纤维性狭窄的治疗选择仅限于内镜和手术治疗。内镜球囊扩张（EBD）似乎是一种安全、微创且有效的替代方法，可以替代或推迟手术。严重并发症很少见，不到 3%的手术中发生。对于没有相邻瘘管或穿孔且长度小于 5 厘米的非复杂狭窄，应考虑 EBD 作为一线治疗。本综述旨在介绍 CD 中小肠和结肠狭窄的内镜管理的现有文献，包括球囊扩张、皮质类固醇和抗肿瘤坏死因子的腔内注射辅助技术，以及金属支架置入。将讨论 EBD 的短期和长期结果、并发症和安全性。
