内镜狭窄成形术治疗IBD与非IBD患者的吻合口狭窄

Endoscopic stricturotomy in the treatment of anastomotic strictures in inflammatory bowel disease(IBD)and non-IBD patients

背景:内镜狭窄成形术(ESt)可有效治疗炎症性肠病(IBD)相关的吻合口狭窄。然而,其用于非IBD患者的吻合口狭窄尚未见报道。本研究旨在评估ESt治疗IBD与非IBD吻合口狭窄的疗效。方法:收集2009-2016年间因吻合口良性狭窄而接受ESt治疗的IBD和非IBD病例的临床资料。主要结局指标是无手术生存时间和治疗相关并发症发生率。结果:49例IBD与15例非IBD患者纳入研究。IBD组包括25例克罗恩病患者和24例溃疡性结肠炎储袋患者。非IBD组原发疾病包括结直肠癌7例,憩室病5例,肠脱垂2例,便秘1例。两组所有患者均成功实施ESt治疗。IBD组出现5例次(4.7%,5/106次ESt)的出血并发症,非IBD组则无一例出现并发症(P=0.20)。在内镜随访中,IBD组和非IBD组分别有10例(20.4%)和5例(33.3%)患者狭窄显著改善(P=0.32);最终分别有6例(12.2%)和4例(26.7%)需要手术解除狭窄(P=0.23)。与非IBD患者相比,IBD患者似乎能维持一个更长的无手术生存时间(P=0.08)。结论:内镜狭窄成形术治疗IBD与非IBD吻合口狭窄的疗效相当,尽管非IBD患者或许有更高的需要后续手术治疗的概率,但其并发症发生率似乎较IBD患者更低。

Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not been described.The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures.Methods:Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted.The primary outcomes were surgery-free survival and procedure-related complications.Results:A total of 49 IBD and 15 non-IBD patients were included in this study.The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches.Underlying diseases in the non-IBD group included colorectal cancer(n=7),diverticulitis(n=5),large bowel prolapse(n=2),and constipation(n=1).Immediate technical success was achieved in all patients in both groups.Bleeding complications occurred on five occasions(4.7%per procedure)in the IBD group,while no complication occurred in the non-IBD group(P=0.20).Stricture improvement on follow-up endoscopy was found in 10(20.4%)and 5(33.3%)patients in the IBD and non-IBD groups,respectively(P=0.32).Six(12.2%)patients in the IBD group and four(26.7%)patients in the non-IBD group eventually required stricture-related surgery(P=0.23).IBD patients appeared to have a higher tendency formaintaining surgery-free after the procedure than non-IBD patients(P=0.08).Conclusions:Endoscopic stricturotomy was shown to have comparable outcomes,though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.