{"title":"Endoscopic dilation of small-intestine strictures in Crohn's disease by balloon-assisted enteroscopy: a systematic review and meta-analysis.","authors":"Vishali Moond, Vikram Jeet Singh Gill, Sheza Malik, Ameya Kasture, Sandesh Parajuli, Suha Soni, Saurabh Chandan, Arkady Broder, Babu P Mohan, Douglas Adler","doi":"10.20524/aog.2024.0920","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD.</p><p><strong>Methods: </strong>We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using <i>I</i> <sup>2</sup> statistics.</p><p><strong>Results: </strong>We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; <i>I</i> <sup>2</sup>=53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; <i>I</i> <sup>2</sup>=71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; <i>I</i> <sup>2</sup>=57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; <i>I</i> <sup>2</sup>=28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; <i>I</i> <sup>2</sup>=3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; <i>I</i> <sup>2</sup>=59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; <i>I</i> <sup>2</sup>=85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; <i>I</i> <sup>2</sup>=44%].</p><p><strong>Conclusion: </strong>BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"682-694"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574157/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.20524/aog.2024.0920","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD.
Methods: We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using I2 statistics.
Results: We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; I2=53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; I2=71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; I2=57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; I2=28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; I2=3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; I2=59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; I2=85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; I2=44%].
Conclusion: BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery.