Cui Lu, Su Min, Ding Yan-Bo, Wang Mei, Sun Ke-Wen
Department of Gastroenterology, The Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu Province, China.
World J Gastrointest Surg. 2025 Feb 27;17(2):100631. doi: 10.4240/wjgs.v17.i2.100631.
Crohn's disease (CD) frequently leads to intestinal strictures, which pose significant challenges due to their complexity and limited treatment options. While medications can address inflammatory strictures, they are largely ineffective for fibrotic and mixed strictures, often necessitating surgical intervention. However, surgery carries considerable risks, including bleeding, infection, anastomotic leaks, and postoperative restricture formation. Endoscopic treatment, particularly endoscopic stricturotomy, offers a minimally invasive alternative that bridges the gap between medication and surgery.
To investigate the safety and efficacy of stricturotomy under single-balloon enteroscopy in stricturing CD.
Patients diagnosed with stricturing CD at The First People's Hospital of Changzhou from June 2020 to April 2024 were enrolled and underwent endoscopic stricturotomy (ES). Relevant clinical data of patients were collected retrospectively. Outcomes included success rate, remission time, complications, and follow-up interventions. This observational study was followed up postoperatively to observe patient remission and recurrence rates.
Seventeen endoscopic strictures were created in 11 patients, achieving a 100% immediate success rate without any serious complications. During the follow-up period, stricture recurrence was observed in two patients, resulting in an endoscopic reintervention rate of 18.2%. Additionally, two patients required subsequent surgical intervention, with a surgical treatment rate of 18.2%. One patient experienced bowel obstruction 18 months post-ES and was successfully managed with conservative treatment without surgical intervention. The remission duration after the initial ES treatment was 10.1 ± 8.2 months, with a median remission time of 10 months.
ES is a safe and effective treatment for CD-related strictures and warrants further clinical promotion and application.
克罗恩病（CD）常导致肠道狭窄，因其复杂性和治疗选择有限而带来重大挑战。虽然药物可治疗炎性狭窄，但对纤维化和混合性狭窄大多无效，常需手术干预。然而，手术有相当大的风险，包括出血、感染、吻合口漏和术后狭窄形成。内镜治疗，尤其是内镜下狭窄切开术，提供了一种微创替代方法，填补了药物治疗和手术治疗之间的空白。
探讨单气囊小肠镜下狭窄切开术治疗狭窄型CD的安全性和有效性。
纳入2020年6月至2024年4月在常州市第一人民医院诊断为狭窄型CD的患者，行内镜下狭窄切开术（ES）。回顾性收集患者的相关临床资料。观察指标包括成功率、缓解时间、并发症及随访干预情况。本观察性研究术后进行随访，观察患者缓解率和复发率。
11例患者共制造了17处内镜下狭窄，即刻成功率达100%，无严重并发症。随访期间，2例患者出现狭窄复发，内镜再干预率为18.2%。此外，2例患者需要后续手术干预，手术治疗率为18.2%。1例患者在ES术后18个月出现肠梗阻，经保守治疗成功处理，未行手术干预。初次ES治疗后的缓解持续时间为10.1±8.2个月，中位缓解时间为10个月。
ES是治疗CD相关狭窄的一种安全有效的方法，值得进一步临床推广应用。
