Zhang Long-Juan, Lan Nan, Wu Xian-Rui, Shen Bo
Laboratory of General Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.
Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Gastroenterol Rep (Oxf). 2019 Oct 21;8(2):143-150. doi: 10.1093/gastro/goz051. eCollection 2020 Apr.
Endoscopic stricturotomy (ESt) has been shown to be effective in treating inflammatory bowel disease (IBD)-associated anastomotic strictures. However, the outcome of ESt in benign, non-IBD conditions has not been described. The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures.
Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted. The primary outcomes were surgery-free survival and procedure-related complications.
A total of 49 IBD and 15 non-IBD patients were included in this study. The IBD group included 25 patients with Crohn's disease and 24 with ulcerative colitis and ileal pouches. Underlying diseases in the non-IBD group included colorectal cancer (=7), diverticulitis (=5), large bowel prolapse (=2), and constipation (=1). Immediate technical success was achieved in all patients in both groups. Bleeding complications occurred on five occasions (4.7% per procedure) in the IBD group, while no complication occurred in the non-IBD group (=0.20). Stricture improvement on follow-up endoscopy was found in 10 (20.4%) and 5 (33.3%) patients in the IBD and non-IBD groups, respectively (=0.32). Six (12.2%) patients in the IBD group and four (26.7%) patients in the non-IBD group eventually required stricture-related surgery (=0.23). IBD patients appeared to have a higher tendency for maintaining surgery-free after the procedure than non-IBD patients (=0.08).
Endoscopic stricturotomy was shown to have comparable outcomes, though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.
内镜下狭窄切开术（ESt）已被证明在治疗炎症性肠病（IBD）相关的吻合口狭窄方面有效。然而，ESt在良性、非IBD疾病中的治疗结果尚未见报道。本研究的目的是评估ESt在治疗IBD和非IBD相关狭窄中的效果。
提取2009年至2016年期间所有接受ESt治疗的连续性IBD和非IBD良性吻合口狭窄患者的数据。主要结局指标为无手术生存率和与手术相关的并发症。
本研究共纳入49例IBD患者和15例非IBD患者。IBD组包括25例克罗恩病患者和24例溃疡性结肠炎及回肠储袋患者。非IBD组的基础疾病包括结肠直肠癌（=7）、憩室炎（=5）、大肠脱垂（=2）和便秘（=1）。两组所有患者均即刻获得技术成功。IBD组发生5次出血并发症（每次手术发生率为4.7%），而非IBD组未发生并发症（=0.20）。IBD组和非IBD组分别有10例（20.4%）和5例（33.3%）患者在随访内镜检查时狭窄得到改善（=0.32）。IBD组6例（12.2%）患者和非IBD组4例（26.7%）患者最终需要进行与狭窄相关的手术（=0.23）。IBD患者术后无手术的维持倾向似乎高于非IBD患者（=0.08）。
内镜下狭窄切开术显示出相当的治疗效果，尽管非IBD患者后续手术需求似乎更高，但并发症发生率低于IBD患者。
