Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
J Gastroenterol Hepatol. 2024 Feb;39(2):353-359. doi: 10.1111/jgh.16384. Epub 2023 Oct 28.
Resection for Crohn's disease (CD) related strictures is definitive but carries risk of morbidity, recurrence, and short bowel syndrome. On the contrary, the durability of endotherapy (ET) for CD-related strictures is questionable. Prospective comparative studies are limited. We aimed to prospectively compare the outcomes of ET in CD strictures with a case-matched surgical therapy (ST) cohort.
Patients undergoing ET or resection for primary CD strictures (symptomatic, non-traversable, < 5 cm length, n ≤ 3) between January 2021 and March 2022 in a high-volume tertiary center were compared with regard to recurrent symptoms, escalation of therapy, re-intervention, and re-operation based on propensity matched analysis.
Fifty-nine patients [49% ET, 57.6% male, median (years): 34 (15-74)] had ≥ 12 months of follow up. Before propensity matching, cumulative re-intervention rate was significantly higher with ET [34.5% (10/29) vs 3.3% (1/30) ST, P = 0.002]. Recurrent symptoms (34.5% vs 26.7%, P = 0.42), escalation of medical therapy (27.5% vs 23.3%, P = 0.64), and re-operation (7.4% vs 3.1%, P = 0.55) were comparable. In propensity matched analysis adjusted for demographics, disease, and stricture characteristics [n = 42, 21 each, 62% male, median (years): 32 (15-60)], cumulative probability of re-intervention rates was higher in ET (28.6% vs 4.8%, P = 0.042). The cumulative probability of recurrent symptoms (ET: 33.3% vs surgery 33.3%, P = 0.93), therapy escalation (ET: 23.8% vs surgery 28.6%, P = 0.75), and re-operation (ET: 9.5% vs surgery 4.8%, P = 0.57) was similar.
ET for CD strictures require higher re-interventions compared with resection although re-operation could be avoided in the majority with comparable symptom free survival at 1 year.
克罗恩病（CD）相关狭窄的切除术是明确的治疗方法，但存在发病风险、复发和短肠综合征的风险。相反，内镜治疗（ET）CD 相关狭窄的持久性是有疑问的。前瞻性对照研究有限。我们旨在前瞻性比较 ET 治疗 CD 狭窄与病例匹配手术治疗（ST）队列的结果。
在一家高容量的三级中心，2021 年 1 月至 2022 年 3 月期间，对因原发性 CD 狭窄（症状性、不可通过、<5cm 长度、n≤3）接受 ET 或切除术的患者进行了比较，比较了复发症状、治疗升级、再干预和再手术的情况，并基于倾向匹配分析进行了比较。
59 例患者[49%为 ET，57.6%为男性，中位（年龄）：34（15-74）岁]随访时间≥12 个月。在倾向匹配之前，ET 的累积再干预率显著更高[34.5%（10/29）vs ST 的 3.3%（1/30），P=0.002]。复发症状（34.5% vs 26.7%，P=0.42）、药物治疗升级（27.5% vs 23.3%，P=0.64）和再次手术（7.4% vs 3.1%，P=0.55）无差异。在调整人口统计学、疾病和狭窄特征的倾向匹配分析中[n=42，21 例，62%为男性，中位（年龄）：32（15-60）岁]，ET 的累积再干预率更高（28.6% vs 4.8%，P=0.042）。ET 的累积复发症状发生率（33.3% vs 手术 33.3%，P=0.93）、治疗升级率（23.8% vs 手术 28.6%，P=0.75）和再次手术率（9.5% vs 手术 4.8%，P=0.57）相似。
与切除术相比，CD 狭窄的 ET 需要更高的再干预，但在大多数情况下可以避免再次手术，1 年时无症状生存率相似。
