Mohamed Talaat Issa, Shafquat Zaman, Ali Yasen Mohamedahmed, Mohammed Hamid, Omar Mostafa, Sangara Narayanasamy, Diwakar Sarma, Rajeev Peravali, Akinfemi Akingboye, Peter Waterland
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引用次数: 0
Abstract
Background: Intestinal strictures are one of the most intractable and common complications of Crohn's disease (CD), and their optimal management remains debatable. Endoscopic balloon dilatation (EBD) and stricturoplasty are advanced minimally invasive therapeutic tools in the management of Crohn's strictures and offer an alternative to surgery. We evaluated outcomes following endoscopic intervention compared with surgical resection in the management of ileocolic anastomotic strictures in patients with CD.
Methods: A comprehensive and systematic search of various electronic databases was conducted. All studies comparing endoscopic intervention with surgical resection for ileocolic anastomotic strictures in patients with CD were included. Our primary outcomes were re-operation or re-dilatation post-intervention and complications including haemorrhage, perforation, leak, and surgical site infection. Other evaluated parameters included the need to escalate medical treatment following primary intervention. RevMan 5.3 was used to perform the data analysis.
Results: Four observational studies with a total of 625 patients were identified and included. This consisted of 355 patients treated surgically and 270 undergoing endoscopic procedures. No significant difference in the risk of re-operation [OR, 0.13; P = 0.19], re-stenosis [OR, 0.58; P = 0.37], or total complications [OR, 1.86; P = 0.34] was seen between the two groups. However, escalation of medical therapy post-intervention was significantly lower in the surgical group compared with those managed endoscopically [OR, 0.19; P = 0.0001].
Conclusion: Both surgical and endoscopic treatments are safe and efficacious in managing patients with anastomotic strictures. However, this review emphasises the need for rationally designed, well-powered, randomised controlled trials to establish best practices in treating these challenging patients.
期刊介绍：
The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies.
The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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