{Reference Type}: Journal Article
{Title}: Endoscopic Balloon Dilatation of Ileal Pouch-Anal Anastomosis Strictures in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.
{Author}: Dahiya DS;Jena A;Bapaye J;Mohan BP;Kassab LL;Facciorusso A;Chandan S;Kochhar GS;
{Journal}: Inflamm Bowel Dis
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 16
{Factor}: 7.29
{DOI}: 10.1093/ibd/izae128
{Abstract}: <B>BACKGROUND: </B>Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for medically refractory inflammatory bowel disease (IBD). In this systematic review and meta-analysis, we assess outcomes and safety of endoscopic balloon dilatation (EBD) for IPAA strictures.<BR><B>METHODS: </B>A systematic search of numerous databases was performed through June 2023 to identify studies reporting on the outcomes of EBD in pouch-related strictures. Outcomes included technical success, clinical success at index dilation and in pouch retention, recurrence of symptoms post-EBD, and adverse events of EBD. Meta-analysis was performed using a random-effects model, and results were expressed in terms of pooled rates along with relevant 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran Q statistical test with I2 statistics.<BR><B>RESULTS: </B>Seven studies with 504 patients were included. The pooled rate of technical success and clinical success of index dilatation was 98.9% (95% CI, 94.8-99.8%; I20%) and 30.2% (95% CI, 7.1-71%; I20%), respectively. The pooled rate of clinical success in pouch retention without the need for additional surgery was 81.4% (95% CI, 69.6-89.3%; I272%). The pooled failure rate of EBD was 18.6% (95% CI, 10.7-30.4%, I272%). The pooled rate of recurrence of symptoms after index dilatation was 58.9% (95% CI, 33.3-80.5%; I213%). The pooled rate of serious adverse events was 1.8% (95% CI, 1-3.5%, I20%). No deaths related to EBD were reported.<BR><B>CONCLUSIONS: </B>Endoscopic balloon dilatation is safe and highly effective for management of IPAA strictures. Additional studies are needed to compare its efficacy with surgical interventions.<BR>In this meta-analysis of 7 studies consisting of 504 inflammatory bowel disease patients with ileal pouch-anal anastomosis strictures, endoscopic balloon dilation was highly safe and effective with excellent clinical and technical success rates.