Abstract：
Strictures are common complications after ileal pouch surgery. The aim of this study is to evaluate the efficacy and safety of endoscopic stricturotomy vs. endoscopic balloon dilation (EBD) in the treatment of pouch inlet strictures.
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.
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.
摘要：
狭窄是回肠袋手术后的常见并发症。这项研究的目的是评估内镜下狭窄切开术的疗效和安全性。内镜下球囊扩张术（EBD）治疗囊袋入口狭窄。
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。
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。
