Efficacy of Endoscopic Dilation of Gastroduodenal Crohn's Disease Strictures: A Systematic Review and Meta-Analysis of Individual Patient Data.
Efficacy of Endoscopic Dilation of Gastroduodenal Crohn's Disease Strictures: A Systematic Review and Meta-Analysis of Individual Patient Data.
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DOI：
10.1016/j.cgh.2018.11.048
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发表时间：
2019-11
期刊：
影响因子：
--
通讯作者：
Rieder F
中科院分区：
文献类型：
--
作者：
Bettenworth D;Mücke MM;Lopez R;Singh A;Zhu W;Guo F;Matsui T;James TW;Herfarth H;Goetz M;Mao R;Kurada S;Hampe J;Matthes K;Karstensen JG;Valli PV;Duijvestein M;D'Haens G;Jairath V;Qiu TB;Ding NS;Rogler G;Rieder F
对于克罗恩病(CD)患者的上胃肠道(UGI)狭窄，内窥镜气囊扩张术(EBD)的疗效知之甚少。我们对EBD治疗UGICD相关狭窄的有效性和安全性进行了综合分析。我们检索了Embase、Medline和Cochrane图书馆，以及相关文章的书目，以寻找截至2016年12月接受EBD治疗的患有CD和胃或十二指肠狭窄(直到Treitz韧带)的成年人的队列研究。我们从7个国际转诊中心获得了94名患者的数据，这些患者接受了141次EBDS。我们对已发表和未发表的队列研究的数据进行了患者水平的荟萃分析，以确定机械和临床的成功。我们进行了事件发生时间分析，以评估症状复发和是否需要矫正或手术。分析的患者有十二指肠狭窄(n=107)、胃狭窄(n=30)或两者兼有(n=4)。EBD的技术成功率为100%，短期临床有效率为87%；主要并发症发生在所有手术中的2.9%。在23.1个月的中位随访期内，70.5%的患者症状复发，59.6%的患者需要矫正，30.8%的患者需要手术治疗。病变位于小肠的患者症状复发的风险更高(风险比[HR]，2.1；P=.003)。亚裔种族(HR，2.8；P<；.001)和小肠病变部位(HR，1.9；P=.004)增加了矫正的需要。狭窄前扩张是早期需要手术的危险因素(HR，1.9；P=.001)。在一项荟萃分析中，我们发现EBD治疗CD相关的UGI狭窄是一种有效的手术替代方法，具有较高的短期技术和临床成功率、中等的长期疗效和可接受的并发症发生率。
Little is known about the effects of endoscopic balloon dilation (EBD) for strictures of the upper gastrointestinal (UGI) tract in patients with Crohn’s disease (CD). We performed a pooled analysis of the efficacy and safety of EBD for UGI CD-associated strictures. We searched Embase, Medline, and the Cochrane library, as well as bibliographies of relevant articles, for cohort studies of adults with CD and strictures of the stomach or duodenum (up to the ligament of Treitz) who underwent EBD through December 2016. We obtained data from 7 international referral centers on 94 patients who underwent 141 EBDs. We performed a patient-level meta-analysis of data from published and unpublished cohort studies to determine mechanical and clinical success. We performed a time-to-event analysis to assess symptom recurrence and need for redilation or surgery. The patients analyzed had strictures of the duodenum (n = 107), stomach (n = 30), or spanning both (n = 4). The rate of technical success for EBD was 100%, with 87% short-term clinical efficacy; major complications arose from 2.9% of all procedures. During a median follow-up period of 23.1 months, 70.5% of patients had a recurrence of symptoms, 59.6% required redilation, and 30.8% required surgical intervention. Patients whose disease was located in the small bowel had a higher risk for symptom recurrence (hazard ratio [HR], 2.1; P = .003). Asian race (HR, 2.8; P < .001) and location of disease in the small bowel (HR, 1.9; P = .004) increased the need for redilation. Prestenotic dilation was a risk factor for needing surgery earlier (HR, 1.9; P = .001). In a meta-analysis, we found EBD for CD-associated strictures of the UGI to be an effective alternative to surgery, with a high rate of short-term technical and clinical success, moderate long-term efficacy, and an acceptable rate of complications.
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