All consecutive ulcerative colitis patients with the diagnosis of pouch inlet or afferent limb strictures treated in our Interventional Inflammatory Bowel Disease Unit (i-IBD) from 2008 to 2017 were extracted. The primary outcomes were surgery-free survival and post-procedural complications.
A total of 200 eligible patients were included in this study, with 40 (20.0%) patients treated with endoscopic stricturotomy and 160 (80.0%) patients treated with EBD. Symptom improvement was recorded in 11 (42.3%) patients treated with endoscopic stricturotomy and 16 (13.2%) treated with EBD. Subsequent surgery rate was comparable between the two groups (9 [22.5%] vs. 33 [20.6%], P = 0.80) during a median follow-up of 0.6 years (interquartile range [IQR] 0.4-0.8) vs. 3.6 years (IQR 1.1-6.2) in patients receiving endoscopic stricturotomy and EBD, respectively. The overall surgery-free survival seems to be comparable as well (P = 0.12). None of the patients in the stricturotomy group developed pouch failure, while 9 patients (5.6%) had pouch failure in the balloon dilation group (P = 0.17). Procedural bleeding was seen in three occasions (4.7% per procedure) in patients receiving endoscopic stricturotomy and perforation was seen in three occasions (0.8% per procedure) in patients receiving EBD (P = 0.02). In multivariable analysis, an increased length of the stricture (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0-1.8) and concurrent pouchitis (HR 2.5, 95% CI 1.0-5.7) were found to be risk factors for the requirement of surgery.
Endoscopic stricturotomy and EBD were both effective in treating patients with pouch inlet or afferent limb strictures, EBD had a higher perforation risk while endoscopic stricturotomy had a higher bleeding risk.
提取了2008年至2017年在我们的介入炎症性肠病病房(i-IBD)治疗的所有诊断为袋入口或传入肢体狭窄的溃疡性结肠炎患者。主要结果是无手术生存率和术后并发症。
本研究共纳入200名符合条件的患者,其中40例(20.0%)患者接受内镜狭窄切开术治疗,160例(80.0%)患者接受EBD治疗。记录了11例(42.3%)接受内镜狭窄切开术治疗的患者和16例(13.2%)接受EBD治疗的患者的症状改善。两组的后续手术率相当(9[22.5%]vs.33[20.6%],P=0.80)在0.6年的中位随访期间(四分位距[IQR]0.4-0.8)与3.6年(IQR1.1-6.2)在接受内镜下狭窄切开术和EBD的患者中,分别。总的无手术生存率似乎也相当(P=0.12)。狭窄切开术组的患者均未出现囊衰竭,而球囊扩张组有9例患者(5.6%)出现囊袋衰竭(P=0.17)。在接受内镜下狭窄切开术的患者中,有3次(每次手术4.7%)见手术性出血,在接受EBD的患者中,有3次(每次手术0.8%)见穿孔(P=0.02)。在多变量分析中,狭窄长度增加(风险比[HR]1.4,95%置信区间[CI]1.0~1.8)和并发囊炎(HR2.5,95%CI1.0~5.7)是需要手术的危险因素.
内镜下狭窄切开术和EBD均可有效治疗囊袋入口或传入肢体狭窄的患者,EBD有较高的穿孔风险,而内镜下狭窄切开术有较高的出血风险。