Moroi Rintaro, Tarasawa Kunio, Nagai Hiroshi, Shimoyama Yusuke, Naito Takeo, Shiga Hisashi, Hamada Shin, Kakuta Yoichi, Fushimi Kiyohide, Fujimori Kenji, Kinouchi Yoshitaka, Masamune Atsushi
Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan.
Gastroenterol Res Pract. 2024 Nov 14;2024:1291965. doi: 10.1155/2024/1291965. eCollection 2024.
Although endoscopic balloon dilation (EBD) is a common therapeutic approach for managing strictures associated with Crohn's disease (CD), the clinical application and complication rates of EBD remain unclear. We collected admission data for patients who underwent EBD using a nationwide database. We compared EBD outcomes between ileal and colonic strictures, CD and ulcerative colitis, and CD and anastomotic strictures arising from cancer-related surgery. Subsequently, propensity score matching was employed to facilitate comparisons between each group. The median duration of hospital stay was 4 days. Endoscopic hemostasis and urgent surgery rates after EBD for CD-related strictures were considerably low (0.035% and 0.11%, respectively). Most patients with CD underwent only one EBD procedure during a single admission. Although no significant differences in patient backgrounds and severe complications were observed between ileal and colonic stricture in CD, multiple EBD procedures were more commonly performed for ileal strictures than for colonic stricture. Moreover, EBD for ileal stricture was more frequently conducted in high-volume centers than in low-volume centers. Regarding severe complications after EBD, no significant differences were observed between CD-related strictures and ulcerative colitis or anastomotic strictures related to cancer surgery. Our findings support the safe and effective use of EBD for both ileal and colonic strictures associated with CD. The clinical practice and safety outcomes of EBD for CD-related strictures were comparable to those for strictures stemming from other etiologies.
尽管内镜下球囊扩张术（EBD）是治疗克罗恩病（CD）相关狭窄的常用方法，但EBD的临床应用及并发症发生率仍不明确。我们利用全国性数据库收集了接受EBD治疗患者的入院数据。我们比较了回肠和结肠狭窄、CD和溃疡性结肠炎、以及CD与癌症相关手术引起的吻合口狭窄之间的EBD治疗效果。随后，采用倾向评分匹配法以方便各组之间的比较。住院时间中位数为4天。CD相关狭窄行EBD后的内镜下止血率和急诊手术率相当低（分别为0.035%和0.11%）。大多数CD患者在单次住院期间仅接受一次EBD治疗。尽管CD患者的回肠和结肠狭窄在患者背景及严重并发症方面未观察到显著差异，但回肠狭窄比结肠狭窄更常进行多次EBD治疗。此外，高容量中心比低容量中心更频繁地对回肠狭窄进行EBD治疗。关于EBD后的严重并发症，CD相关狭窄与溃疡性结肠炎或癌症手术相关的吻合口狭窄之间未观察到显著差异。我们的研究结果支持EBD安全有效地用于治疗与CD相关的回肠和结肠狭窄。CD相关狭窄的EBD临床实践及安全性结果与其他病因引起的狭窄相当。
