Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn's disease strictures
Safety and efficacy of endoscopic dilation for primary and anastomotic Crohn's disease strictures
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DOI：
10.1016/j.crohns.2013.10.001
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发表时间：
2014-05-01
影响因子：
8
通讯作者：
Shen, Bo
中科院分区：
文献类型：
--
作者：
Atreja, Ashish;Aggarwal, Ashish;Shen, Bo
背景资料：克罗恩病（CD）狭窄内镜扩张的文献，特别是原发性（非吻合口）strictures is limited.Methods：在我们的IBD中心接受内镜狭窄扩张CD的患者进行了一项历史队列研究。主要终点是与吻合口狭窄相比，首次内镜扩张在预防原发性狭窄需要手术方面的有效性。采用稳健的夹心协方差矩阵估计的考克斯比例风险模型来评估手术和任何进一步内镜干预的需求。在我们的研究队列中，（平均年龄42.2 ± 13.1岁，57%女性，16.4%当前吸烟者，中位随访时间1.8年），128例患者共接受了430次内镜狭窄扩张术，其中169例狭窄（88例原发性狭窄，81例继发性狭窄）。42例患者（32.8%）在随访期间需要手术，首次扩张和手术之间的平均间隔期为33个月。原发性狭窄或吻合口狭窄在手术需求（34.1% vs. 29.6%，p = 0.53）、再扩张（59.1% vs. 58%，p = 0.89）或总干预（手术+再扩张，71.6% vs. 72.8%，p = 0.86）方面无差异。多变量分析并没有显示任何显着差异患者接受和不接受intralesional类固醇注射，生物制剂或免疫调节剂方面的需要重复干预或surgery.Conclusion：疗效和安全性内镜扩张是相似的原发性和吻合口CD狭窄。病灶内类固醇注射或使用生物制剂并没有减少原发性或吻合口狭窄的再次介入或手术的需要。(C)2013年欧洲克罗恩病和结肠炎组织。Elsevier B.V.出版，保留所有权利。
Background: Literature on endoscopic dilation of Crohn's disease (CD) strictures, especially for primary (non-anastomotic) strictures is limited.Methods: A historical cohort study was performed on patients who underwent endoscopic stricture dilations for CD in our IBD center. Primary endpoint was the efficacy of first endoscopic dilation in preventing the need for surgery in primary strictures compared to anastomotic strictures. Cox proportional hazards models using robust sandwich covariance matrix estimate were used to evaluate the need for surgery and any further endoscopic intervention.Results: In our study cohort (mean age 42.2 13.1 years, 57% females, 16.4% current smokers, and median follow-up 1.8 years), 128 patients underwent a total of 430 endoscopic stricture dilations for 169 strictures (88 primary, 81 secondary). Forty-two patients (32.8%) required surgery in the follow-up period, with a mean interval period between first dilation and surgery of 33 months. There was no difference between primary or anastomotic strictures with respect to the need for surgery (34.1% vs. 29.6%, p = 0.53), redilation (59.1% vs. 58%, p = 0.89) or total interventions (surgery + redilations, 71.6% vs. 72.8%, p = 0.86). Multivariable analysis did not show any significant difference between patients who received and did not receive intralesional steroid injections, biologics or immunomodulators with respect to the need for repeat intervention or surgery.Conclusion: Efficacy and safety of endoscopic dilation are similar between primary and anastomotic CD strictures. Intralesional steroid injection or use of biologics did not decrease the need for re-intervention or surgery for either primary or anastomotic strictures. (C) 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.