Moroi Rintaro, Shiga Hisashi, Kuroha Masatake, Kanazawa Yoshitake, Nochioka Kotaro, Kakuta Yoichi, Kinouchi Yoshitaka, Masamune Atsushi
Division of Gastroenterology, Tohoku University Hospital, Miyagi, Japan.
Clinical Research, Innovation and Education Center, Tohoku University Hospital, Miyagi, Japan.
Endosc Int Open. 2020 Jan;8(1):E81-E86. doi: 10.1055/a-1027-6921. Epub 2020 Jan 8.
Intestinal stricture associated with Crohn's disease (CD) is usually treated by endoscopic balloon dilation (EBD) or stricture plasty. Although EBD is effective and safe for such strictures, refractory stricture after EBD poses a problem. Hence, other novel approaches for these refractory strictures are required. On the other hand, the efficacy of radial incision and cutting (RIC) method for esophageal stricture after esophagogastric surgery is reported. In this pilot study, we adopted the RIC technique for five CD patients with refractory intestinal stricture to dilate their strictures. We conducted the RIC procedure using an electric needle knife with a ceramic tip on the top of the needle. Four cases were of anastomotic stricture after ileocecal resection and the remaining one case was of stricture due to mucosal healing. The RIC procedure was successful for all five patients. Average procedure time was 18.6 minutes. One patient developed delayed bleeding after RIC. There were no cases of perforation. RIC could be an alternative therapy for intestinal stricture associated with CD. Further studies should be conducted to clarify its efficacy and safety.
与克罗恩病（CD）相关的肠道狭窄通常采用内镜球囊扩张术（EBD）或狭窄成形术进行治疗。尽管EBD对此类狭窄有效且安全，但EBD后难治性狭窄仍是一个问题。因此，需要针对这些难治性狭窄的其他新方法。另一方面，有报道称放射状切开和切割（RIC）方法对食管胃手术后的食管狭窄有效。在这项前瞻性研究中，我们对5例患有难治性肠道狭窄的CD患者采用RIC技术来扩张其狭窄部位。我们使用顶部带有陶瓷尖端的电针刀进行RIC操作。4例为回盲部切除术后吻合口狭窄，其余1例为黏膜愈合所致狭窄。所有5例患者的RIC操作均成功。平均操作时间为18.6分钟。1例患者在RIC后出现延迟性出血。无穿孔病例。RIC可能是治疗与CD相关的肠道狭窄的一种替代疗法。应进行进一步研究以阐明其疗效和安全性。
