介入性炎症性肠病(IBD)在复杂IBD治疗中的作用:来自印度一家三级中心的初步前瞻性经验

IF 0.4 Q4 GASTROENTEROLOGY & HEPATOLOGY
P. Pal, M. Ramchandani, R. Banerjee, P. Inavolu, Z. Nabi, H. Rughwani, A. Singh, Rajendra Patel, Polina Vijayalaxmi, J. Singh, P. Rebala, G. Rao, D. Reddy, M. Tandan
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引用次数: 2

摘要

摘要背景/目的 随着复杂炎症性肠病(IBD)管理的多学科实践模式的不断发展和IBD发病率的不断上升,介入性IBD(IIBD)有望发挥关键作用。我们旨在评估IIBD目前在印度的作用及其短期成果。方法 在2021年9月至2022年5月期间,前瞻性纳入了因狭窄、出血、结肠炎相关肿瘤、治疗性小肠内窥镜检查(包括保留胶囊取出)和术后并发症而接受IIBD手术的IBD患者。记录人口统计学和疾病细节、适应症、初次和再次手术细节、技术/临床成功率和并发症。后果 在2021年9月至2022年4月期间,共有54名患者(61%为男性,中位年龄:37.5岁,范围:21-74岁,克罗恩病[CD]:42,溃疡性结肠炎[UC]:12)接受了IIBD手术。44名患者(56处狭窄,9%吻合口,9%小袋)接受了内镜球囊扩张术(EBD),他们在63次手术中总共接受了83次EBD手术。最大扩张后的短期临床疗效、技术成功率(即EBD后通过镜检查)和并发症(均为轻度)分别为95.4%、81.8%和9.1%。在短期随访(1-8个月,中位数:5个月)中,27.3%的患者出现复发症状,其中放疗、手术和内镜下狭窄切开术分别占22.7%、2.3%和2.3%。在小肠EBD期间,对4名患者进行了电动螺旋肠镜引导下的保留型胶囊内窥镜取出。溃疡性结肠炎相关肿瘤(UCAN)在6名患者中进行了内镜切除(内镜黏膜下剥离术(ESD)-1,内镜黏膜切除术(EMR)-5)。两名患者切除了高度发育不良(1名复发性UCAN的ESD,1名接受水下EMR治疗的EMR有残留肿瘤)。R0切除率为83.3%。内镜下止血采用止血夹和硬化疗法治疗UC相关出血,其中2例CD伴近端回肠出血,采用顺行单球囊肠镜辅助止血夹控制。结论 IIBD在印度等资源有限的环境中是一种很有前途的模式,它是医学治疗和外科手术之间的桥梁。手术可以在很大程度上避免,短期效果良好。需要对长期结果进行评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India
Abstract Background/Aims  With the growing multidisciplinary model of practice in the management of complex inflammatory bowel disease (IBD) and rising incidence of IBD, interventional IBD (IIBD) promises to play a key role. We aimed to evaluate current the role of IIBD in India and its short-term outcomes. Methods  IBD patients undergoing IIBD procedures for stricture, bleeding, colitis-associated neoplasia, therapeutic small bowel endoscopy including retained capsule retrieval and postsurgical complications were enrolled prospectively between September 2021 and May 2022. Demographic and disease details, indications, initial and redo procedure details, technical/clinical success, and complications were recorded. Results  IIBD procedures were performed in total 54 patients (61% males, median age: 37.5 years, range: 21–74 years, Crohn's disease [CD]: 42, ulcerative colitis [UC]: 12 between September 2021 and April 2022). Endoscopic balloon dilation (EBD) was performed in 44 patients (56 strictures, 9% anastomotic, 9% pouch) who underwent total 83 EBD procedures in 63 sessions. Short-term clinical efficacy after maximal dilation, technical success (i.e., scope passage after EBD), and complications (all mild) were noted in 95.4, 81.8, and 9.1%, respectively. Recurrent symptoms were seen in 27.3% on short-term follow-up (1–8 months, median: 5 months) for which redilation, surgery, and endoscopic stricturotomy were done in 22.7, 2.3, and 2.3% respectively. During small bowel EBD, motorized spiral enteroscopy-guided retained capsule endoscope retrieval was done in four patients. Ulcerative colitis-associated neoplasia (UCAN) was resected endoscopically in six patients (endoscopic submucosal dissection (ESD)—1, endoscopic mucosal resection (EMR)—5). High-grade dysplasia was resected in two patients (1 ESD for recurrent UCAN, 1 EMR had residual neoplasia on follow-up treated with underwater EMR). R0 resection was achieved in 83.3%. Endoscopic hemostasis was done with hemoclipping and sclerotherapy for UC-related bleeding in two, whereas a case of CD with proximal ileal bleeding was controlled with antegrade single-balloon enteroscopy-assisted hemoclipping. Conclusions  IIBD is a promising modality in resource-limited settings like India acting as a bridge between medical therapy and surgery. Surgery can be avoided in a significant proportion with good short-term outcomes. Long-term outcomes need to be evaluated.
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来源期刊
Journal of Digestive Endoscopy
Journal of Digestive Endoscopy GASTROENTEROLOGY & HEPATOLOGY-
自引率
28.60%
发文量
35
审稿时长
22 weeks
期刊介绍: The Journal of Digestive Endoscopy (JDE) is the official publication of the Society of Gastrointestinal Endoscopy of India that has over 1500 members. The society comprises of several key clinicians in this field from different parts of the country and has key international speakers in its advisory board. JDE is a double-blinded peer-reviewed, print and online journal publishing quarterly. It focuses on original investigations, reviews, case reports and clinical images as well as key investigations including but not limited to cholangiopancreatography, fluoroscopy, capsule endoscopy etc.
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