Hong Sung Noh, Kim Ji Eun, Kim Eun Ran, Chang Dong Kyung, Kim Young-Ho
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
United European Gastroenterol J. 2025 Jul;13(6):958-970. doi: 10.1002/ueg2.12775. Epub 2025 Mar 26.
The long-term outcomes of enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease are not well understood. Although Crohn's strictures can be classified into web-like, ulcerated, and spindle-shaped strictures based on endoscopic findings, the outcomes of enteroscopic balloon dilation according to the shape of Crohn's strictures have not been analyzed. The primary outcome was to evaluate the cumulative surgery-free rate, and the secondary outcome was to evaluate the risk factor for subsequent surgery after enteroscopic balloon dilation.
This prospective, longitudinal, observational study enrolled patients with Crohn's disease who underwent enteroscopic balloon dilation for small bowel strictures using single-balloon enteroscopy between 2015 and 2023 at Samsung Medical Center, Seoul, Korea.
A total of 150 consecutive patients who underwent 235 enteroscopic balloon dilations were included in this study with a mean follow-up of 42.4 ± 19.1 months. Thirty-one patients (20.7%) underwent surgery after enteroscopic balloon dilation, and the cumulative 1-, 3-, and 5-year surgery-free rates were 86.7%, 80.4%, and 76.6%, respectively. The cumulative surgery-free rates of enteroscopic balloon dilation for web-like, ulcerated, and spindle-shaped strictures were 96.3%, 91.0%, and 73.3% at 1 year, 96.3%, 84.9%, and 63.0% at 3 years, and 96.3%, 78.3%, and 63.0% at 5 years, respectively (p = 0.001). Multivariate Cox regression analysis identified spindle-shaped stricture (vs. web-like stricture: hazard ratio [HR], 13.33; 95% confidence interval [CI], 1.48-120.24, p = 0.021), ulcerated stricture (vs. web-like stricture: HR, 8.50; 95% CI, 1.05-69.03, p = 0.045), and conventional therapy only (vs. biologic therapy: HR, 2.51; 95% CI, 1.11-5.71; p = 0.028) as risk factors for surgery after enteroscopic balloon dilation. The major complication rate of enteroscopic balloon dilations was 2.7% (4/150) on per-patient analysis and 1.7% (4/235) on per-procedure analysis.
Enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease may be an effective and safe alternative to surgery. Enteroscopic balloon dilation for web-like strictures showed favorable outcomes and biologic therapy following enteroscopic balloon dilation may be helpful to avoid surgery.
克罗恩病患者小肠狭窄行肠镜下球囊扩张的长期疗效尚不清楚。尽管根据内镜检查结果，克罗恩狭窄可分为网状、溃疡型和纺锤形狭窄，但尚未分析根据克罗恩狭窄形状进行肠镜下球囊扩张的疗效。主要结局是评估累计无手术率，次要结局是评估肠镜下球囊扩张后后续手术的危险因素。
这项前瞻性、纵向、观察性研究纳入了2015年至2023年在韩国首尔三星医疗中心因小肠狭窄接受单气囊肠镜下球囊扩张的克罗恩病患者。
本研究共纳入150例连续接受235次肠镜下球囊扩张的患者，平均随访42.4±19.1个月。31例患者（20.7%）在肠镜下球囊扩张后接受了手术，1年、3年和5年的累计无手术率分别为86.7%、80.4%和76.6%。网状、溃疡型和纺锤形狭窄的肠镜下球囊扩张1年累计无手术率分别为96.3%、91.0%和73.3%，3年分别为96.3%、84.9%和63.0%，5年分别为96.3%、78.3%和63.0%（p=0.001）。多因素Cox回归分析确定纺锤形狭窄（与网状狭窄相比：风险比[HR]，13.33；95%置信区间[CI]，1.48-120.24，p=0.021）、溃疡型狭窄（与网状狭窄相比：HR，8.50；95%CI，1.05-69.03，p=0.045）以及仅接受传统治疗（与生物治疗相比：HR，2.51；95%CI，1.11-5.71；p=0.028）是肠镜下球囊扩张后手术的危险因素。肠镜下球囊扩张的主要并发症发生率在患者分析中为2.7%（4/150），在每例手术分析中为1.7%（4/235）。
克罗恩病患者小肠狭窄行肠镜下球囊扩张可能是一种有效且安全的手术替代方法。网状狭窄的肠镜下球囊扩张显示出良好的疗效，肠镜下球囊扩张后进行生物治疗可能有助于避免手术。
