Interventional Inflammatory Bowel Disease (i-IBD) Unit and Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Interventional Inflammatory Bowel Disease (i-IBD) Unit and Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Gastrointest Endosc. 2019 Aug;90(2):259-268. doi: 10.1016/j.gie.2019.01.021. Epub 2019 Jan 30.
Endoscopic stricturotomy (ESt) is a novel technique in the treatment of anastomotic strictures in Crohn's disease (CD). The aim of this study was to compare the outcome of patients with ileocolonic anastomotic stricture treated with ESt versus ileocolonic resection (ICR).
This historical cohort study included consecutive CD patients with ileocolonic anastomotic stricture treated with ESt or ICR from 2010 to 2017. The primary outcomes were surgery-free survival and postprocedural adverse events.
Thirty-five patients treated with ESt and 147 patients treated with ICR were analyzed. Median follow-up was .8 years (interquartile range [IQR], .2-1.7) and 2.2 years (IQR, 1.2-4.4) in the ESt and ICR groups, respectively (P < .001). Subsequent stricture-related surgery was needed in 4 patients (11.3%) receiving ESt and in 15 patients (10.2%) receiving ICR (P = .83). Kaplan-Meier analysis also showed no statistical difference regarding surgery-free survival between the 2 groups (P = .24). Procedure-related major adverse events were documented in 5 of 49 patients (10.2% per procedure) undergoing ESt and 47 patients (31.9%) undergoing ICR (P = .003). Risk factors for decreased surgery-free survival on multivariate analysis included preprocedural corticosteroids (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.0-8.1), multiple strictures (HR, 4.9; 95% CI, 1.7-14.2), and increased disease-related hospitalizations (HR, 4.0; 95% CI, 1.2-13.0).
With the limitation of a shorter follow-up, ESt achieved comparable surgery-free survival with a decreased morbidity when compared with ICR.
内镜下狭窄切开术（ESt）是一种治疗克罗恩病（CD）吻合口狭窄的新方法。本研究旨在比较 ESt 与肠切除术（ICR）治疗回结肠吻合口狭窄患者的结局。
这是一项回顾性队列研究，纳入了 2010 年至 2017 年期间接受 ESt 或 ICR 治疗的回结肠吻合口狭窄的 CD 患者。主要结局为无手术生存和术后不良事件。
分析了 35 例接受 ESt 治疗和 147 例接受 ICR 治疗的患者。ESt 和 ICR 组的中位随访时间分别为.8 年（四分位距 [IQR]，.2-1.7）和 2.2 年（IQR，1.2-4.4）（P<0.001）。ESt 组有 4 例（11.3%）和 ICR 组有 15 例（10.2%）需要再次行狭窄相关手术（P=0.83）。Kaplan-Meier 分析显示，两组无手术生存差异无统计学意义（P=0.24）。ESt 组有 5 例（10.2%）和 ICR 组有 47 例（31.9%）发生与操作相关的主要不良事件（P=0.003）。多变量分析显示，术前使用皮质类固醇（风险比 [HR]，2.8；95%置信区间 [CI]，1.0-8.1）、多发狭窄（HR，4.9；95% CI，1.7-14.2）和疾病相关住院次数增加（HR，4.0；95% CI，1.2-13.0）是无手术生存降低的危险因素。
ESt 与 ICR 相比，在缩短随访时间的情况下，具有相似的无手术生存率，且发病率较低。
