Patel Parth, Patel Manav, Ebrahim Mohamad Ayman, Loganathan Priyadarshini, Adler Douglas G
Department of Internal Medicine, Saint Joseph Hospital, Chicago (Parth Patel, Mohamad Ayman Ebrahim).
Department of Medicine, Smt. NHL Municipal Medical College, India (Manav Patel).
Ann Gastroenterol. 2025 Jan-Feb;38(1):60-67. doi: 10.20524/aog.2024.0929. Epub 2024 Dec 12.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a common surgical procedure for ulcerative colitis and familial adenomatous polyposis. IPAA strictures are a known complication, often requiring surgical intervention. Endoscopic interventions offer a less invasive alternative, but their safety and efficacy remain uncertain.
A comprehensive literature search was performed to identify pertinent studies. Outcomes assessed were technical success, clinical success (immediate and end of follow up), pouch failure rate and adverse events. Pooled estimates were calculated using random effects models with a 95% confidence interval.
A total of 607 patients from 9 studies were included. Technical success, defined as the ability to pass the endoscope through the stricture, was achieved in 97.4% of patients. Immediate clinical success, defined as symptom improvement post-intervention, was seen in 44.5% of patients. Clinical success at the end of follow up was observed in 81.7% of patients. However, 6.8% of patients experienced pouch failure and ultimately 14.5% required surgical intervention for refractory strictures or complications. Endoscopic intervention-related serious adverse events occurred in 3.9% of patients, including perforation and major post-procedural bleeding.
Endoscopic interventions for IPAA strictures demonstrate high technical success rates, providing a less invasive option for managing this complication. While clinical success rates immediately post-procedure and at end of follow up are promising, a significant proportion of patients ultimately require surgical intervention for pouch failure or refractory strictures.
回肠储袋肛管吻合术（IPAA）的结直肠修复性切除术是治疗溃疡性结肠炎和家族性腺瘤性息肉病的常见外科手术。IPAA狭窄是一种已知的并发症，通常需要手术干预。内镜干预提供了一种侵入性较小的替代方法，但其安全性和有效性仍不确定。
进行全面的文献检索以确定相关研究。评估的结果包括技术成功率、临床成功率（即刻和随访结束时）、储袋失败率和不良事件。使用具有95%置信区间的随机效应模型计算合并估计值。
共纳入9项研究中的607例患者。技术成功率定义为内镜能够通过狭窄部位，97.4%的患者实现了技术成功。即刻临床成功率定义为干预后症状改善，44.5%的患者出现了即刻临床成功。随访结束时的临床成功率在81.7%的患者中观察到。然而，6.8%的患者出现储袋失败，最终14.5%的患者因难治性狭窄或并发症需要手术干预。3.9%的患者发生了与内镜干预相关的严重不良事件，包括穿孔和术后大出血。
IPAA狭窄的内镜干预显示出较高的技术成功率，为处理这种并发症提供了一种侵入性较小的选择。虽然术后即刻和随访结束时的临床成功率很有前景，但相当一部分患者最终因储袋失败或难治性狭窄需要手术干预。
