Endoscopic Stricturotomy for Enteral Nutrition Access in Patients with Benign Gastrointestinal Strictures:a Review

Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstructing the enteral nutrition pathway in patients with gastrointestinal strictures.Endoscopic stricturotomy is a safe and effective way to open the nutritional pathway,especially for those with anatomic stricture length<1 cm,and can be used either as the primary choice of treatment for patients with gastrointestinal stricture or as rescue therapy for refractory cases.Endoscopic stricturotomy can be executed with radial incision and cutting or circular incision and cutting.After the stricturotomy,other endoscopic treatments,such as endoscopic balloon dilation,stent implantation,and intra-lesional injection of steroids,can be used to prevent the development of re-stricture.This article reviews the clinical experiences with endoscopic stricturotomy for opening strictures along the enteral nutrition pathway in patients with gastrointestinal strictures.

内镜狭窄成形术治疗IBD与非IBD患者的吻合口狭窄

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。