Schulberg Julien D, Hamilton Amy L, Wright Emily K, Holt Bronte A, Sutherland Tom R, Ross Alyson L, Vogrin Sara, Kamm Michael A
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Department of Radiology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Gastrointest Endosc. 2025 Jan;101(1):202-206.e4. doi: 10.1016/j.gie.2024.09.031. Epub 2024 Sep 27.
Crohn's disease strictures are usually treated by a single endoscopic balloon dilation (EBD). We postulated repeat EBD and needle-knife stricturotomy (NKSt), together with inflammation controlled by intense drug therapy, may be more effective.
Twenty-one patients with symptomatic strictures were randomized to a single EBD or intensive treatment with 3 balloon dilations 3 weeks apart and/or NKSt.
Of 21 patients, 2 of 5 (40%) undergoing a single EBD and 12 of 16 (72%) undergoing intensive treatment had symptom improvement (odds ratio, 4.49; 95% confidence interval, .54-37.4; P = .164). Eleven patients received >1 EBD without NKSt and 5 underwent ≥1 NKSt. NKSt-treated patients and those with concurrent intensified drug treatment had the best outcomes.
Treatment for Crohn's disease strictures with repeat dilations or stricturotomy is feasible and safe and may improve stricture outcomes. Concurrent intensified drug treatment to eliminate inflammation is also associated with improved outcomes. (Clinical trial registration number: NCT03222011.).
克罗恩病狭窄通常通过单次内镜球囊扩张术（EBD）进行治疗。我们推测，重复EBD和针刀狭窄切开术（NKSt），再加上通过强化药物治疗控制炎症，可能会更有效。
21例有症状的狭窄患者被随机分为单次EBD组或接受强化治疗组，强化治疗包括每隔3周进行3次球囊扩张和/或NKSt。
21例患者中，接受单次EBD的5例中有2例（40%）症状改善，接受强化治疗的16例中有12例（72%）症状改善（优势比为4.49；95%置信区间为0.54 - 37.4；P = 0.164）。11例患者接受了>1次EBD但未进行NKSt，5例患者接受了≥1次NKSt。接受NKSt治疗的患者以及同时接受强化药物治疗的患者预后最佳。
采用重复扩张或狭窄切开术治疗克罗恩病狭窄是可行且安全的，可能会改善狭窄的治疗效果。同时进行强化药物治疗以消除炎症也与改善治疗效果相关。（临床试验注册号：NCT03222011。）
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