小肠狭窄性克罗恩病的肠镜球囊扩张:一项单中心前瞻性观察研究的长期结果和手术危险因素

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Sung Noh Hong, Ji Eun Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim
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引用次数: 0

摘要

背景和目的:小肠镜下球囊扩张治疗克罗恩病患者小肠狭窄的长期结果尚不清楚。虽然根据内窥镜的表现可将克罗恩狭窄分为网状、溃疡和梭形狭窄,但根据克罗恩狭窄的形状进行肠镜球囊扩张的结果尚未得到分析。主要结局是评估累积无手术率,次要结局是评估肠镜球囊扩张后后续手术的危险因素。方法:这项前瞻性、纵向、观察性研究纳入了2015年至2023年在韩国首尔三星医疗中心接受单气囊肠镜检查的小肠狭窄的克罗恩病患者。结果:本研究共纳入150例连续接受了235例肠镜球囊扩张术的患者,平均随访时间为42.4±19.1个月。31例(20.7%)患者在肠镜球囊扩张后接受手术,累计1、3、5年无手术率分别为86.7%、80.4%、76.6%。肠镜球囊扩张治疗网状、溃烂和梭形狭窄的累计无手术率在1年时分别为96.3%、91.0%和73.3%,在3年时为96.3%、84.9%和63.0%,在5年时分别为96.3%、78.3%和63.0% (p = 0.001)。多因素Cox回归分析确定纺锤形狭窄(vs.网状狭窄:风险比[HR], 13.33;95%可信区间[CI], 1.48-120.24, p = 0.021),溃疡性狭窄(相对于网状狭窄:HR, 8.50;95% CI, 1.05-69.03, p = 0.045),仅接受常规治疗(相对于生物治疗:HR, 2.51;95% ci, 1.11-5.71;P = 0.028)为肠镜球囊扩张术后手术的危险因素。在每个患者分析中,肠镜球囊扩张的主要并发症发生率为2.7%(4/150),在每个手术分析中为1.7%(4/235)。结论:对于克罗恩病患者的小肠狭窄,肠镜球囊扩张可能是一种有效和安全的替代手术。肠镜下球囊扩张治疗网状狭窄显示出良好的结果,在肠镜下球囊扩张后进行生物治疗可能有助于避免手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Enteroscopic Balloon Dilation in Small Bowel Stricturing Crohn's Disease: Long-Term Outcomes and Risk Factors for Surgery in a Single-Center Prospective Observational Study.

Background and aims: The long-term outcomes of enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease are not well understood. Although Crohn's strictures can be classified into web-like, ulcerated, and spindle-shaped strictures based on endoscopic findings, the outcomes of enteroscopic balloon dilation according to the shape of Crohn's strictures have not been analyzed. The primary outcome was to evaluate the cumulative surgery-free rate, and the secondary outcome was to evaluate the risk factor for subsequent surgery after enteroscopic balloon dilation.

Methods: This prospective, longitudinal, observational study enrolled patients with Crohn's disease who underwent enteroscopic balloon dilation for small bowel strictures using single-balloon enteroscopy between 2015 and 2023 at Samsung Medical Center, Seoul, Korea.

Results: A total of 150 consecutive patients who underwent 235 enteroscopic balloon dilations were included in this study with a mean follow-up of 42.4 ± 19.1 months. Thirty-one patients (20.7%) underwent surgery after enteroscopic balloon dilation, and the cumulative 1-, 3-, and 5-year surgery-free rates were 86.7%, 80.4%, and 76.6%, respectively. The cumulative surgery-free rates of enteroscopic balloon dilation for web-like, ulcerated, and spindle-shaped strictures were 96.3%, 91.0%, and 73.3% at 1 year, 96.3%, 84.9%, and 63.0% at 3 years, and 96.3%, 78.3%, and 63.0% at 5 years, respectively (p = 0.001). Multivariate Cox regression analysis identified spindle-shaped stricture (vs. web-like stricture: hazard ratio [HR], 13.33; 95% confidence interval [CI], 1.48-120.24, p = 0.021), ulcerated stricture (vs. web-like stricture: HR, 8.50; 95% CI, 1.05-69.03, p = 0.045), and conventional therapy only (vs. biologic therapy: HR, 2.51; 95% CI, 1.11-5.71; p = 0.028) as risk factors for surgery after enteroscopic balloon dilation. The major complication rate of enteroscopic balloon dilations was 2.7% (4/150) on per-patient analysis and 1.7% (4/235) on per-procedure analysis.

Conclusions: Enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease may be an effective and safe alternative to surgery. Enteroscopic balloon dilation for web-like strictures showed favorable outcomes and biologic therapy following enteroscopic balloon dilation may be helpful to avoid surgery.

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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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