Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine
Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine
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DOI：
10.5217/ir.2019.09150
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发表时间：
2020-04-01
影响因子：
4.9
通讯作者：
Andoh, Akira
中科院分区：
文献类型：
--
作者：
Morita, Yasuhiro;Bamba, Shigeki;Andoh, Akira
背景/目的：我们回顾分析了克罗恩病(CD)合并小肠狭窄的患者接受单气囊小肠镜(SBE)检查，以确定具有被动弯曲机制和高力传递插入管的原型SBE是否比传统SBE具有更好的小肠可插入性。方法：在253例接受SBE的CD患者中，我们确定了94名曾因小肠狭窄接受过内窥镜球囊扩张(EBD)的CD患者，纳入本研究。我们分析了初始手术中使用的手术范围类型是否影响累积的无手术率。为了进行可插入性分析，根据使用的范围类型，将接受至少两次SBE的患者分为3组：仅常规SBE组、仅原型SBE组、常规SBE组和原型SBE组。对于每组，比较同一患者在不同时间点的插入深度、手术时间和EBD数量。结果：EBD成功率为88.3%。5年和10年累积无手术率分别为75.7%和72.8%。Cox回归分析表明，导致手术的因素是长狭窄(<2 cm)、EBD失败和克罗恩病活动指数升高，但不是EBD所使用的镜的类型。植入深度显著增加(P=0.03，Wilcoxon‘s符号等级检验)。结论：在CD合并小肠狭窄的患者中，具有被动弯曲机制和高力传递插入管的原型SBES不能改善EBD的长期预后，但确实改善了深度可插入性。(临床试验注册编号UMIN000037102)
Background/Aims: We retrospectively analyzed Crohn's disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE. Methods: Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points. Results: The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (>= 2 cm), EBD failure, and elevated Crohn's Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon's signed-rank test). Conclusions: In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)