Peng Bo, Liu Zhongcheng, Wang Biyao, Ke Jia, Guo Qin
Department of Small Bowel Endoscopy, The Sixth Affiliated Hospital, Sun Yat-Sen University, No. 26 Yuancun Road II, Tianhe District, Guangzhou, 510000, People's Republic of China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
Surg Endosc. 2025 May 27. doi: 10.1007/s00464-025-11784-4.
A common complication which can influence the prognosis of Crohn's disease (CD) is multi-segmental strictures, and there are limitations to using either surgical or endoscopic treatment alone. We aimed to treat multi-segmental strictures in CD using combination of surgery and endoscopic therapy and to evaluate the efficacy and safety of conventional surgery combined with endoscopic stricturotomy for the treatment of deep small bowel multi-segmental fibrotic strictures.
21 patients with CD who underwent conventional surgery combined with endoscopic stricturotomy between January 2020 and December 2023 were included. Outcomes included immediate technical success, short- and long-term clinical efficacy, risk factors assessment, and analysis of adverse events. No risk factors were identified that would predict re-intervention.
The overall immediate success rate of the combined technique was 100%, with a 98.4% success rate for the endoscopic procedure alone. 85.7% of patients showed significant improvement in obstructive symptoms compared to the previous period, and only 9.5% required enteral nutrition, with the remainder resuming a regular diet by 8 weeks (all P < 0.0001). The median follow-up of the 21 patients was 528 days (IQR, 404-1296), with a one-year no re-intervention rate of 81.7% (95% CI, 70.6-90.2%). The incidence of adverse events of the procedure was 19%, 14% bleeding and 5% perforation, but all could be managed with intraoperative interventions without the need for postoperative re-intervention.
Surgery combined with endoscopic stricturotomy is a safe and effective treatment of multi-segmental fibrotic strictures in CD may provide a novel treatment option for strictures in CD.
多节段狭窄是一种可影响克罗恩病（CD）预后的常见并发症，单独使用手术或内镜治疗均存在局限性。我们旨在采用手术与内镜治疗相结合的方法治疗CD中的多节段狭窄，并评估传统手术联合内镜下狭窄切开术治疗深部小肠多节段纤维化狭窄的疗效和安全性。
纳入2020年1月至2023年12月期间接受传统手术联合内镜下狭窄切开术的21例CD患者。观察指标包括即刻技术成功率、短期和长期临床疗效、危险因素评估以及不良事件分析。未发现可预测再次干预的危险因素。
联合技术的总体即刻成功率为100%，单纯内镜手术成功率为98.4%。与术前相比，85.7%的患者梗阻症状有显著改善，仅9.5%的患者需要肠内营养，其余患者在8周时恢复正常饮食（所有P<0.0001）。21例患者的中位随访时间为528天（四分位间距，404-1296），一年无再次干预率为81.7%（95%CI，70.6-90.2%）。该手术不良事件发生率为19%，出血占14%，穿孔占5%，但所有不良事件均可通过术中干预处理，无需术后再次干预。
手术联合内镜下狭窄切开术是治疗CD多节段纤维化狭窄的一种安全有效的方法，可能为CD狭窄提供一种新的治疗选择。
