术前肠超声引导下克罗恩病升结肠狭窄合并盲肠结石的混合内镜狭窄切开及球囊扩张

Q3 Medicine

VideoGIE Pub Date : 2025-10-01 DOI:10.1016/j.vgie.2025.05.005

Partha Pal MD, DNB, MRCP (UK), FASGE , Mohammad Abdul Mateen MD , Rajesh Gupta MD, DM , Manu Tandan MD, DM , D. Nageshwar Reddy MD, DM

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引用次数: 0

摘要

背景和目的克罗恩病（CD）狭窄的治疗已经发展成为一种微创手术的替代方法。内镜下狭窄切开术（ES）和球囊扩张术（EBD）相结合的混合技术可以改善预后。肠超声（IUS）已成为一种即时评估狭窄的工具。我们报告了一例术前eus引导下混合ES和EBD治疗伴有近端粪石的CD患者。方法一例47岁男性回肠结肠CD患者（蒙特利尔分类A2， L3, B2）接受阿达木单抗和硫唑嘌呤治疗，出现复发性梗阻性症状。IUS发现一个短的，主要是纤维化的升结肠狭窄。6个月前的计算机断层扫描排除了额外的狭窄。结肠镜检查时，使用绝缘尖端刀进行ES，然后进行EBD至12 mm。切除多余粘膜，控制小出血。成功穿过狭窄，取出粪石。结果手术过程顺利，患者在阿达木单抗升级治疗后第二天出院。在9个月的随访中，他没有任何症状。结论术前IUS引导下的混合ES和EBD是治疗CD狭窄的有效的多模式方法，有可能延迟或避免手术。需要进一步的研究来验证IUS在狭窄管理中的长期作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Hybrid endoscopic stricturotomy and balloon dilation of ascending colon stricture with cecal fecaliths in Crohn’s disease guided by preprocedural intestinal ultrasound

Background and Aims

Endotherapy for Crohn’s disease (CD) strictures has evolved as a minimally invasive alternative to surgery. Hybrid techniques combining endoscopic stricturotomy (ES) and balloon dilation (EBD) can improve outcomes. Intestinal ultrasound (IUS) has emerged as a point-of-care tool for stricture assessment. We present a case using preprocedural IUS-guided hybrid ES and EBD to manage an ascending colon stricture with proximal fecaliths in CD.

Methods

A 47-year-old man with ileocolonic CD (Montreal classification A2, L3, B2) receiving adalimumab and azathioprine presented with recurrent obstructive symptoms. IUS identified a short, predominantly fibrotic, ascending colon stricture. Earlier computed tomography enterography 6 months back ruled out additional strictures. On colonoscopy, ES was performed using an insulated-tip knife, followed by EBD up to 12 mm. Redundant mucosa was excised, and minor bleeding controlled. The stricture was successfully traversed, and fecaliths were extracted.

Results

The procedure was uneventful, and the patient was discharged the next day after adalimumab escalation. At 9-month follow-up, he remained symptom-free.

Conclusions

Hybrid ES and EBD guided by preprocedural IUS offer an effective multimodal approach for CD strictures, potentially delaying or avoiding surgery. Further studies are warranted to validate the long-term role of IUS in stricture management.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.