Endoscopic stricturotomy and ileo-colonic resection in patients with primary Crohn’s disease-related distal ileum strictures  

内镜狭窄切开术对比回结肠切除术治疗克罗恩病原发性末端回肠狭窄

作　　者：Nan Lan Tracy L.Hull Bo Shen 

机构地区：[1]Center for Inflammatory Bowel Disease,Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH,USA [2]Present affiliation:Center for Inflammatory Bowel Diseases,Columbia University Irving Medical Center-New York Presbyterian Hospital,New York,NY 10032,USA.Fax.[phone].

出　　处：《Gastroenterology Report》2020年第4期312-318,I0002,共8页胃肠病学报道（英文）

摘　　要：Background:Stricture is a common presentation of Crohn’s disease with the site of prevalence being the distal ileum.This study aimed to compare the efficacy and safety of patients with primary distal ileum stricture treated with endoscopic stricturotomy(ESt)vs ileo-colonic resection(ICR).Methods:All consecutive patients with primary distal ileum stricture that were treated with ESt and/or ICR were extracted from the interventional inflammatory bowel disease(i-IBD)unit from 2001 to 2016.All patients with a stricture>5cmor those with anastomotic strictures were excluded from the study.The primary outcomes were surgery-free survival and post-procedural complications.Results:A total of 13 patients receiving ESt and 32 patients receiving ICR were included in this study.Although the length of the stricture is comparable between the two groups(2.460.9 vs 3.061.1 cm,P=0.17),patients who received surgery had a more complicated obstruction presented by the high pre-stenosis proximal dilation rate(67.7%vs 9.1%,P=0.001).All patients in both groups achieved immediate technical success after treatment.Themedian follow-up durations were 1.8 and 1.5 years in the ESt and ICR groups,respectively.The subsequent surgery rates were similar between the two groups(15.4%vs 18.8%,P=0.79)and the overall surgery-free survival was also comparable between the two groups(P=0.98).Post-procedural adverse events were seen in 2/29 ESt procedures(6.9%per procedure)and 8/32(25.0%)patients receiving ICR(P=0.05).Conclusions:ESt achieved comparable stricture-related surgery-free survival as ICR,while ESt had a numerically lower post-operative complication rate.背景:狭窄是克罗恩病的常见表现,绝大多数狭窄出现在末端回肠。本研究旨在比较内镜狭窄切开术(ESt)与回结肠切除术(ICR)治疗克罗恩病原发性末端回肠狭窄的有效性和安全性。方法:从干预性炎症性肠病(i-IBD)中心提取2001-2016年间接受ESt和(或)ICR治疗的克罗恩病原发性末端回肠狭窄的连续病例。排除狭窄长度>5 cm或吻合口狭窄者。主要结局指标是无手术生存期和术后并发症。结果:13例行ESt和32例行ICR治疗的患者纳入研究。尽管两组患者狭窄长度相当[(2.46±0.9)cm vs(3.06±1.1)cm,P=0.17],但ICR组患者更多合并梗阻,表现为狭窄前近端肠管扩张(67.7%vs 9.1%,P=0.001)。两组患者治疗后均成功解除梗阻。ESt组和ICR组中位随访时间中位随访时间分别为1.8年和1.5年,再手术率相当(15.4%vs 18.8%,P=0.79),无手术生存率的差异亦无统计学意义(P=0.98)。29次ESt术后出现2例次不良反应,而32次ICR术后则出现了8例次不良反应(6.9%vs 25.0%,P=0.05)。结论:ESt可取得与ICR相当的无狭窄相关手术生存时间,但ESt术后并发症发生率似乎更低。

关 键 词：Crohn’s disease STRICTURE ENDOSCOPY stricturotomy RESECTION 

分 类 号：R574[医药卫生—消化系统]