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ESt Effective for Treating Crohn’s Strictures
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Using endoscopic stricturotomy to treat ileocolonic anastomotic strictures in Crohn’s disease achieved similar surgery-free survival when compared with ileocolonic resection, according to research published in Gastrointestinal Endoscopy.
Bo Shen, MD, FASGE, of the Interventional Inflammatory Bowel Disease Unit at the Cleveland Clinic, and colleagues wrote that resection is common in these patients, but there can be complications.
“Although effective, surgical treatment is often associated with postoperative adverse events and secondary anastomotic strictures,” they wrote. “Our group described an immediate
technical success rate of 100% and subsequent surgery rate of 15.3% in IBD patients treated with [endoscopic stricturotomy (ESt)]. We also proved the superior efficacy of ESt in the treatment of [ileocolonic anastomotic (ICA)] stricture in CD patients when compared to [endoscopic balloon dilation (EBD)]. However, outcomes of ESt and [ileocolonic resection (ICR)] in the treatment of ICA strictures have not been directly compared.”
Researchers conducted a historical cohort study that included consecutive patents with CD with ICA stricture treated with ESt (n = 35) or ICR (n = 147) between 2010 and 2017. The primary outcomes were surgery-free survival and postprocedural adverse events.
Investigators found that four patients in the ESt group needed subsequent stricture-related surgery (11.3%) compared with 15 patients in the ICR group (10%), however the difference was not statistically significant.
Fewer patients in the ESt group experienced procedure-related major adverse events compared with the ICR group (10.2% vs. 32% per procedure; P = .003).
Researchers identified the following as risk factors for decreased surgery-free survival: preprocedural corticosteroid use (HR = 2.8; 95% CI, 1–8.1), multiple strictures (HR = 4.9; 95% CI, 1.7–14.2) and increased disease-related hospitalizations (HR = 4; 95% CI, 1.2–13).
Shen and colleagues wrote that a shorter median follow-up in the ESt group put a limitation on the study and called for additional research.
“ESt may be considered as one of the first-line therapies due to its comparable efficacy to and lower adverse event rate than ICR in suitable patients in experienced hands with surgical backup,” they wrote. “Although repeat ESt sessions may be needed, this technique may delay or avoid a surgical resection for a stricture at a previous ileocolonic anastomosis.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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