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Endoscopic needle knife stricturotomy safe, effective for treating strictures in IBD
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A novel endoscopic procedure called needle knife stricturotomy was safe and effective for treating strictures in a study of patients with inflammatory bowel disease, and thus may provide an alternative to endoscopic balloon dilation and surgery.
“We pioneered this procedure,” Bo Shen, MD, medical director of Cleveland Clinic’s IBD Center, said in a press release. “Our research shows that it is effective and can have advantages over other conventionally used treatments, such as medical therapy, balloon dilation and surgery.”
Bo Shen
Shen and his colleague Nan Lan, MD, reviewed registry data on 85 patients with IBD whose strictures were treated by needle knife stricturotomy at the Cleveland Clinic from 2008 to 2016. Most (89.4%) were white, 45.9% were women, the mean age was 24.4 years, 58.8% had ulcerative colitis with ileal pouch, 37.6% had Crohn’s ileitis, 3.5% had Crohn’s colitis, 27.1% were on biologics and 90.6% had had a previous IBD-related surgery.
Overall, 35.3% of these patients had multiple strictures, so 127 strictures were treated in total (median length, 1.5 cm; 41.6% endoscopically non-traversable), and patients received a median of two procedures, so a total of 272 needle knife stricturotomies were performed.
Passing the endoscope through the stricture immediately after the procedure was successful in all patients.
Through a median follow-up period of 0.9 years, 15.3% of patients required surgery for their strictures, while 60.6% required an additional needle knife stricturotomy, endoscopic balloon dilation or both.
Adverse events occurred in 3.7% of procedures, including delayed bleeding and one perforation that required hospitalization.
Shen and Lan concluded that proper use of needle knife stricturotomy can help patients avoid the need for stricture-related surgeries, which can improve their quality of life.
“Multiple bowel resection surgeries can shorten patients’ intestinal tracts while noninvasive procedures preserve them,” Shen said in the press release.
Notably, Shen and Lan found that the length of time between endoscopic and surgical interventions, and from treatment to structure recurrence was longer.
“For example, if you need [endoscopic balloon dilation] every 3 months, you need it every 6 months after [needle knife stricturotomy],” Shen said in the press release.
The technology also provides physicians with more precision when opening strictures, he added. “You have more control over how deep you cut and where you cut,” he said. “With the needle knife, you can avoid the front wall of the rectum. You cut only the back wall, so you can avoid ... complications [like fistulas]. This is a major advantage.”
Shen and Lan will present their findings and lead a CME presentation on the procedure at DDW 2017.
“It’s a procedure with some risks involved, so intense training is important,” he said in the press release. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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