Morita Yasuhiro, Bamba Shigeki, Inatomi Osamu, Takahashi Kenichiro, Imai Takayuki, Murata Masaki, Ohno Masashi, Sasaki Masaya, Tsujikawa Tomoyuki, Andoh Akira
Department of Medicine, Shiga University of Medical Science, Otsu, Japan.
Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan.
Intest Res. 2020 Apr;18(2):229-237. doi: 10.5217/ir.2019.09150. Epub 2020 Apr 9.
BACKGROUND/AIMS: We retrospectively analyzed Crohn's disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE.
Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points.
The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn's Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon's signed-rank test).
In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102).
背景/目的：我们回顾性分析了接受单气囊小肠镜检查（SBE）的克罗恩病（CD）小肠狭窄患者，以确定具有被动弯曲机制和高力传递插入管的原型SBE在小肠中的插入性是否优于传统SBE。
在253例行SBE的CD患者中，我们确定了94例行小肠狭窄内镜下球囊扩张术（EBD）的CD患者纳入本研究。我们分析了初次手术所用内镜类型是否影响累计无手术率。对于插入性分析，至少接受过两次SBE的患者根据所用内镜类型分为三组：仅使用传统SBE、仅使用原型SBE以及同时使用传统和原型SBE。对每组患者在不同时间点的插入深度、操作时间和EBD次数进行比较。
EBD成功率为88.3%。5年和10年累计无手术率分别为75.7%和72.8%。Cox回归分析表明，导致手术的因素为长狭窄（≥2 cm）、EBD失败和克罗恩病活动指数升高，而非EBD所用内镜类型。原型SBE显著提高了插入深度（P = 0.03，Wilcoxon符号秩检验）。
在患有小肠狭窄的CD患者中，具有被动弯曲机制和高力传递插入管的原型SBE并未改善EBD的长期效果，但提高了深部插入性。（临床试验注册号：UMIN000037102）
