Department of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA.
Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA.
Inflamm Bowel Dis. 2023 Jul 5;29(7):1145-1152. doi: 10.1093/ibd/izac153.
Crohn's disease (CD) is a chronic progressive condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD, but data on its safety and efficacy are limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD-related strictures.
A systematic and detailed search was run in January 2022 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD-related strictures. Meta-analysis was performed using random-effects model, and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CIs).
Nine studies with 163 patients were included in the final analysis. Self-expanding metal stents (SEMS) including both partial and fully covered were used in 7 studies, whereas biodegradable stents were used in 2 studies. Pooled rate of clinical success and technical success was 60.9% (95% CI, 51.6-69.5; I2 = 13%) and 93% (95% CI, 87.3-96.3; I2 = 0%), respectively. Repeat stenting was needed in 9.6% of patients (95% CI, 5.3-16.7; I2 = 0%), whereas pooled rate of spontaneous stent migration was 43.9% (95% CI, 11.4-82.7; I2 = 88%). Pooled incidence of overall adverse events, proximal stent migration, perforation, and abdominal pain were 15.7%, 6.4%, 2.7%, and 17.9%, respectively. Mean follow-up period ranged from 3 months to 69 months.
Endoscopic stenting in CD-related strictures is a safe technique that can be performed with technical ease, albeit with a limited clinical success. Postprocedure abdominal pain and proximal stent migration are some of the common adverse events reported.
克罗恩病（CD）是一种慢性进行性疾病，在初始诊断后 10 年内，近 30%的病例会并发肠道或结肠狭窄。内镜球囊扩张（EBD）有穿孔的风险，5 年内的复发率高达 60%。内镜支架置入术已被用作 EBD 的替代方法，但关于其安全性和疗效的数据有限。我们进行了一项系统评价和荟萃分析，以评估内镜支架置入术在 CD 相关狭窄中的治疗效果。
在医学图书馆员的协助下，于 2022 年 1 月进行了系统而详细的检索，以查找报告 CD 相关狭窄内镜支架置入术治疗效果的研究。使用随机效应模型进行荟萃分析，结果以合并比例及其相关 95%置信区间（CI）表示。
最终分析纳入了 9 项研究，共 163 例患者。7 项研究中使用了自膨式金属支架（SEMS），包括部分覆盖和完全覆盖，2 项研究中使用了可生物降解支架。临床成功率和技术成功率的合并率分别为 60.9%（95%CI，51.6-69.5；I2=13%）和 93%（95%CI，87.3-96.3；I2=0%）。9.6%的患者需要重复支架置入（95%CI，5.3-16.7；I2=0%），而合并的支架自发性迁移率为 43.9%（95%CI，11.4-82.7；I2=88%）。总体不良事件、近端支架迁移、穿孔和腹痛的合并发生率分别为 15.7%、6.4%、2.7%和 17.9%。平均随访时间为 3 至 69 个月。
CD 相关狭窄内镜支架置入术是一种安全的技术，虽然临床成功率有限，但操作简单。报告的常见不良事件包括术后腹痛和近端支架迁移。
