Indirect comparison of endoscopic balloon dilatation, stent placement, and stricturotomy for lower gastrointestinal strictures in Crohn's disease: a systematic review and meta-analysis.

Abstract

Background and aims: Outcomes of endoscopic balloon dilatation (EBD), endoscopic stent placement (ESP), and endoscopic stricturotomy for Crohn's disease-related strictures vary across studies. We conducted an indirect meta-analysis to synthesize and compare outcomes.

Methods: Data were extracted from multiple online databases. Primary outcomes of interest were: clinical success and technical success. Secondary outcomes of interest were: rate of adverse events, the rates of repeat endoscopic procedures, and surgery. Pooled proportions along with 95% confidence interval (CI) and odds ratio (OR) of each outcome were calculated.

Results: We analyzed 39 studies: 25 on EBD (n = 1353), nine on ESP (n = 159), and five on endoscopic stricturotomy (n = 102). Pooled outcomes for EBD, ESP, and endoscopic stricturotomy, respectively, were: technical success (88, 93, and 95%), clinical success (62, 59, and 49%), adverse events (7, 25, and 17%), repeat procedures (17, 7, and 56%), and surgery (13, 25, and 9%). Compared with EBD, endoscopic stricturotomy showed significantly higher repeat endoscopy rates (OR = 6.165, 95% CI: 2.328-6.328, P < 0.05). Both endoscopic stricturotomy and ESP had higher adverse event rates than EBD (endoscopic stricturotomy: OR = 2.610, 95% CI: 1.095-6.221; ESP: OR = 4.214, 95% CI: 2.070-8.579; both P < 0.05). Differences in clinical and technical success, repeat procedures with ESP, and surgery were NS.

Conclusion: Clinical and technical success were not significantly different between EBD, ESP, and endoscopic stricturotomy for Crohn's disease-related strictures. However, adverse events and repeat procedures were higher in ESP and endoscopic stricturotomy when compared with EBD.