A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn's disease
A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn's disease
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DOI：
10.1007/s00535-020-01670-2
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发表时间：
2020-01-27
影响因子：
6.3
通讯作者：
Hibi, Toshifumi
中科院分区：
文献类型：
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作者：
Bamba, Shigeki;Sakemi, Ryosuke;Hibi, Toshifumi
背景小肠狭窄是克罗恩病（CD）患者最常见的并发症之一。内窥镜球囊扩张（EBD）是一种旨在避免手术的微创治疗方法;然而，EBD是否会阻止后续手术仍不清楚。我们的目的是揭示小肠狭窄患者手术的因素以及与初始EBD后后续手术相关的因素。方法回顾性收集2008年后出现症状性小肠狭窄的未经手术治疗的CD患者的数据，当时使用球囊辅助肠镜和抗肿瘤坏死因子（TNF）维持治疗可用。结果共纳入32个三级转诊中心的305例患者。1年累积无手术生存率为74.0%，5年为54.4%，10年为44.3%。与避免手术相关的因素包括非狭窄、发病时非穿透性疾病、症状严重程度较轻、EBD成功、狭窄长度< 2 cm以及出现阻塞症状后添加免疫调节剂或抗TNF。在95例初始EBD成功的病例中，较长的EBD间期与较低的手术风险相关。受试者操作特征分析显示，
Background Small bowel stricture is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD. Methods Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available. Results A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of