A Pooled Analysis of Efficacy, Safety, and Long-term Outcome of Endoscopic Balloon Dilation Therapy for Patients with Stricturing Crohn's Disease
A Pooled Analysis of Efficacy, Safety, and Long-term Outcome of Endoscopic Balloon Dilation Therapy for Patients with Stricturing Crohn's Disease
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DOI：
10.1097/mib.0000000000000988
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发表时间：
2017-01-01
影响因子：
4.9
通讯作者：
Rieder, Florian
中科院分区：
文献类型：
--
作者：
Bettenworth, Dominik;Gustavsson, Anders;Rieder, Florian
背景：内镜球囊扩张（EBD）广泛用于治疗克罗恩病相关狭窄。然而，大多数关于安全性和有效性的研究都是小型和异质性的。我们对已发表的研究进行了综合分析，并评估了676个综合性个体参与者数据集，以确定EBD的总体影响。方法：对1991年至2013年Embase、MEDLINE和科克伦图书馆的引文进行了系统回顾，并对相关出版物的引用文献进行了评估。我们从包括≥ 15名患者的研究中收集数据，并额外生成了一个独特的个体患者数据库，其中包含来自12项研究的676个个体数据集。技术的可行性，短期和长期的疗效，和safety进行了evaluated.Results：在1463例克罗恩病患者进行了3213 EBD程序，98.6%的狭窄是回肠和62%吻合。EBD的技术成功率为89.1%，临床有效率为80.8%。每次手术的并发症发生率为2.8%。随访24个月后，73.5%的受试者接受了再扩张，42.9%的受试者接受了手术切除。在对676例患者的多变量分析中，
Background: Endoscopic balloon dilation (EBD) is widely used to manage Crohn's disease-associated strictures. However, most studies of the safety and efficacy are small and heterogenous. We performed a combined analysis of published studies and evaluated 676 comprehensive individual participant data sets to determine the overall effects of EBD.Methods: Citations from the Embase, MEDLINE, and the Cochrane library from 1991 through 2013 were systematically reviewed, and references of cited articles were assessed for relevant publications. We collected data from studies including >= 15 patients and additionally generated a unique individual patient database containing 676 individual data sets derived from 12 studies. Technical feasibility, short-term and long-term efficacies, and safety were evaluated.Results: In 1463 patients with Crohn's disease who underwent 3213 EBD procedures, 98.6% of strictures were ileal and 62% anastomotic. The technical success rate of the EBDs was 89.1% with a clinical efficacy of 80.8%. Complications occurred in 2.8% per procedure. After 24 months of follow-up, 73.5% of subjects underwent redilation and 42.9% surgical resection. In a multivariate analysis of 676 individual patients, a stricture length of