Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, United States.
Inflamm Bowel Dis. 2021 Jul 27;27(8):1230-1236. doi: 10.1093/ibd/izaa276.
Patients with Crohn disease (CD) often develop strictures that require surgery. Endoscopic balloon dilation (EBD) is an alternative treatment that can be safe and effective. The objective of this study was to assess factors associated with the need for repeat EBD and surgery after initial EBD for stricturing CD.
Patients with stricturing CD who underwent EBD from 2007 to 2017 were identified. Demographic and clinical information was obtained from the electronic medical record. A Cox proportional hazards regression model and Kaplan-Meier curves were generated for variables associated with repeat EBD and surgical resection.
Ninety-nine patients underwent a total of 240 EBD proedures; 35% had a history of perianal disease, and 63% were on a biologic at the time of initial EBD. Fifty-one percent of patients had obstructive symptoms at the time of initial EBD, and 75% of the EBDs were successful. Complications occurred in 8 EBDs (3.3%). Repeat intervention after EBD was more likely in patients on biologics at baseline EBD (76% vs 54%; P = 0.029). Thirty-three percent of patients had surgical resection at a median of 5 months (interquartile ratio = 2.0-13.0 months) after initial EBD. The presence of obstructive symptoms at the time of EBD was associated with surgical resection (hazard ratio = 3.18; 95% confidence interval, 1.28-7.86). Conversely, a history of perianal disease was negatively associated with surgical resection (hazard ratio = 0.27; 95% confidence interval, 0.10-0.68).
Patients on biologic treatment at the time of EBD are more likely to need an intervention in the future. Patients with obstructive symptoms at the time of initial EBD and those without a history of perianal involvement are more likely to undergo surgical intervention.
克罗恩病（CD）患者常发生狭窄，需要手术治疗。内镜下球囊扩张（EBD）是一种替代治疗方法，可安全有效。本研究的目的是评估初始 EBD 治疗狭窄性 CD 后，再次行 EBD 和手术的相关因素。
回顾性分析 2007 年至 2017 年间行 EBD 的狭窄性 CD 患者。从电子病历中获取人口统计学和临床资料。使用 Cox 比例风险回归模型和 Kaplan-Meier 曲线生成与再次 EBD 和手术切除相关的变量。
99 例患者共行 240 次 EBD 治疗；35%有肛周疾病史，63%在初始 EBD 时使用生物制剂；51%的患者在初始 EBD 时有梗阻症状，75%的 EBD 成功。8 次 EBD 发生并发症（3.3%）。基线 EBD 时使用生物制剂的患者再次干预的可能性更高（76%比 54%；P=0.029）。33%的患者在初始 EBD 后 5 个月（中位数，2.0-13.0 个月）行手术切除。EBD 时存在梗阻症状与手术切除相关（风险比=3.18；95%置信区间，1.28-7.86）。相反，有肛周疾病史与手术切除呈负相关（风险比=0.27；95%置信区间，0.10-0.68）。
EBD 时使用生物制剂治疗的患者未来更需要干预。初始 EBD 时存在梗阻症状且无肛周疾病史的患者更可能行手术干预。
