From the Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Hôpitaux Universitaire Robert-Debré, APHP, Paris, France.
J Pediatr Gastroenterol Nutr. 2023 Jul 1;77(1):62-69. doi: 10.1097/MPG.0000000000003783. Epub 2023 Mar 28.
OBJECTIVE/BACKGROUND: Endoscopic balloon dilatation (EBD) has been shown to be effective and safe in adults with stricturing Crohn disease (CD) yet pediatric data is sparse. We aimed to assess efficacy and safety of EBD in stricturing pediatric CD.
International collaboration included 11 centers from Europe, Canada, and Israel. Recorded data included patient demographics, stricture features, clinical outcomes, procedural adverse events, and need for surgery. Primary outcome was surgery-free over 12 months and secondary outcomes were clinical response and adverse events.
Eighty-eight dilatations were performed over 64 dilatation series in 53 patients. Mean age at CD diagnosis was 11.1 (±4.0) years, stricture length 4 cm [interquartile range (IQR) 2.8-5], and bowel wall thickness 7 mm (IQR 5.3-8). Twelve of 64 (19%) patients underwent surgery in the year following the dilatation series, at a median of 89 days (IQR 24-120; range 0-264) following EBD. Seven of 64 (11%) had subsequent unplanned EBD over the year, of whom two eventually underwent surgical resection. Two of 88 (2%) perforations were recorded, 1 of whom was managed surgically, and 5 patients had minor adverse events managed conservatively. There was a significant improvement in all clinical measures following EBD with weighted pediatric CD activity index-defined remission increasing from 13% at baseline to 44%, 46%, and 61%, and absence of obstructive symptoms in 55%, 53%, and 64% of patients at week 2, 8, and 24 respectively.
In this largest study of EBD in pediatric stricturing CD to date, we demonstrated that EBD is effective in relieving symptoms and avoiding surgery. Adverse events rates were low and consistent with adult data.
目的/背景：内镜球囊扩张（EBD）已被证明在成人狭窄型克罗恩病（CD）中是有效且安全的，但儿科数据很少。我们旨在评估 EBD 在狭窄型儿科 CD 中的疗效和安全性。
国际合作包括来自欧洲、加拿大和以色列的 11 个中心。记录的数据包括患者人口统计学、狭窄特征、临床结果、程序不良事件和手术需求。主要结果是 12 个月内无手术，次要结果是临床反应和不良事件。
53 名患者的 64 个扩张系列中进行了 88 次扩张。CD 诊断时的平均年龄为 11.1（±4.0）岁，狭窄长度为 4cm[四分位距（IQR）2.8-5]，肠壁厚度为 7mm（IQR 5.3-8）。在扩张系列后的一年中，12 例（19%）患者接受了手术，在 EBD 后中位数为 89 天（IQR 24-120；范围 0-264）。在一年中，7 例（11%）计划外再次进行了 EBD，其中 2 例最终接受了手术切除。记录到 2 例（2%）穿孔，其中 1 例经手术治疗，5 例患者出现轻微不良事件经保守治疗。EBD 后所有临床指标均有显著改善，加权儿科 CD 活动指数定义的缓解率从基线时的 13%增加到 44%、46%和 61%，分别有 55%、53%和 64%的患者在第 2、8 和 24 周时没有梗阻症状。
在迄今为止最大的儿科狭窄型 CD 内镜球囊扩张研究中，我们证明 EBD 可有效缓解症状并避免手术。不良事件发生率低，与成人数据一致。
