Hiram Menezes Nascimento Filho, Angelo So Taa Kum, Alexandre Moraes Bestetti, Pedro Henrique Veras Ayres da Silva, Megui Marilia Mansilla Gallegos, Adérson Omar Mourão Cintra Damião, Udayakumar Navaneethan, Eduardo Guimarães Hourneaux de Moura
{"title":"内镜下球囊扩张术成功治疗克罗恩病相关性回盲部-结肠狭窄后长期疗效的患者相关因素:系统回顾与元分析》。","authors":"Hiram Menezes Nascimento Filho, Angelo So Taa Kum, Alexandre Moraes Bestetti, Pedro Henrique Veras Ayres da Silva, Megui Marilia Mansilla Gallegos, Adérson Omar Mourão Cintra Damião, Udayakumar Navaneethan, Eduardo Guimarães Hourneaux de Moura","doi":"10.1093/crocol/otae041","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Successful Crohn's disease (CD) therapy relies on timely and precise management strategies. Endoscopic balloon dilation (EBD) has been applied as a first-line treatment for symptomatic CD-associated strictures due to its minimally invasive nature and the possibility of preserving intestinal length.</p><p><strong>Objective: </strong>The aim of the present study was to determine patient-related predictive factors associated with the need for surgery for CD-associated ileocolic strictures after technically successful EBD.</p><p><strong>Methods: </strong>All original studies published before December 2023 that reported the outcomes of patients treated with EBD for ileocolic strictures secondary to CD and described follow-up for at least 1 year were included. The difference in risk of needing surgery was calculated for 8 different patient characteristics (Sex, smoking habit, previous surgery, biologic therapy, steroids, immunosuppressors, nature of the stricture, and endoscopic disease activity).</p><p><strong>Results: </strong>There were significant differences in the risk of needing surgery after EBD among patients who underwent surgery and patients without a history of surgery (RD: -0.20 [-0.31, -0.08]), patients with endoscopic mucosal activity and patients in remission at the time of EBD (RD: 0.19 [0.04, 0.34]), patients using biologics at the time of EBD and patients not using biologics (RD: -0.09 [-0.16, -0.03]), and patients using steroids and those not using steroids at the time of EBD (RD: 0.16 [0.07, 0.26]).</p><p><strong>Conclusions: </strong>The use of biologics and endoscopic disease remission at the time of EBD were protective factors against the need for surgery. No previous surgery or use of steroids at the time of EBD was associated with the need for surgery during follow-up.</p>","PeriodicalId":10847,"journal":{"name":"Crohn's & Colitis 360","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339545/pdf/","citationCount":"0","resultStr":"{\"title\":\"Patient-Related Factors Associated With Long-Term Outcomes After Successful Endoscopic Balloon Dilation For Crohn's Disease-Associated Ileo-Colic Strictures: A Systematic Review and Meta-analysis.\",\"authors\":\"Hiram Menezes Nascimento Filho, Angelo So Taa Kum, Alexandre Moraes Bestetti, Pedro Henrique Veras Ayres da Silva, Megui Marilia Mansilla Gallegos, Adérson Omar Mourão Cintra Damião, Udayakumar Navaneethan, Eduardo Guimarães Hourneaux de Moura\",\"doi\":\"10.1093/crocol/otae041\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Successful Crohn's disease (CD) therapy relies on timely and precise management strategies. Endoscopic balloon dilation (EBD) has been applied as a first-line treatment for symptomatic CD-associated strictures due to its minimally invasive nature and the possibility of preserving intestinal length.</p><p><strong>Objective: </strong>The aim of the present study was to determine patient-related predictive factors associated with the need for surgery for CD-associated ileocolic strictures after technically successful EBD.</p><p><strong>Methods: </strong>All original studies published before December 2023 that reported the outcomes of patients treated with EBD for ileocolic strictures secondary to CD and described follow-up for at least 1 year were included. The difference in risk of needing surgery was calculated for 8 different patient characteristics (Sex, smoking habit, previous surgery, biologic therapy, steroids, immunosuppressors, nature of the stricture, and endoscopic disease activity).</p><p><strong>Results: </strong>There were significant differences in the risk of needing surgery after EBD among patients who underwent surgery and patients without a history of surgery (RD: -0.20 [-0.31, -0.08]), patients with endoscopic mucosal activity and patients in remission at the time of EBD (RD: 0.19 [0.04, 0.34]), patients using biologics at the time of EBD and patients not using biologics (RD: -0.09 [-0.16, -0.03]), and patients using steroids and those not using steroids at the time of EBD (RD: 0.16 [0.07, 0.26]).</p><p><strong>Conclusions: </strong>The use of biologics and endoscopic disease remission at the time of EBD were protective factors against the need for surgery. No previous surgery or use of steroids at the time of EBD was associated with the need for surgery during follow-up.</p>\",\"PeriodicalId\":10847,\"journal\":{\"name\":\"Crohn's & Colitis 360\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-08-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339545/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Crohn's & Colitis 360\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/crocol/otae041\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Crohn's & Colitis 360","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/crocol/otae041","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:克罗恩病(CD)的成功治疗有赖于及时和精确的管理策略。内镜下球囊扩张术(EBD)因其微创性和保留肠道长度的可能性,已被用作治疗症状性 CD 相关狭窄的一线疗法:本研究旨在确定与患者相关的预测因素,这些因素与技术上成功的 EBD 后 CD 相关性回结肠狭窄是否需要手术相关:方法:纳入2023年12月之前发表的所有原始研究,这些研究报告了继发于CD的回结肠狭窄患者接受EBD治疗的结果,并描述了至少1年的随访。根据 8 种不同的患者特征(性别、吸烟习惯、既往手术、生物治疗、类固醇、免疫抑制剂、狭窄性质和内镜下疾病活动性)计算需要手术的风险差异:接受过手术的患者与没有手术史的患者(RD:-0.20 [-0.31,-0.08])、有内镜粘膜活动的患者与 EBD 时病情缓解的患者(RD:0.19[0.04,0.34])、EBD时使用生物制剂的患者和未使用生物制剂的患者(RD:-0.09 [-0.16,-0.03])、EBD时使用类固醇的患者和未使用类固醇的患者(RD:0.16 [0.07,0.26]).结论:结论:EBD时使用生物制剂和内镜下疾病缓解是避免手术的保护因素。EBD发生时未进行过手术或使用类固醇与随访期间的手术需求有关。
Patient-Related Factors Associated With Long-Term Outcomes After Successful Endoscopic Balloon Dilation For Crohn's Disease-Associated Ileo-Colic Strictures: A Systematic Review and Meta-analysis.
Background: Successful Crohn's disease (CD) therapy relies on timely and precise management strategies. Endoscopic balloon dilation (EBD) has been applied as a first-line treatment for symptomatic CD-associated strictures due to its minimally invasive nature and the possibility of preserving intestinal length.
Objective: The aim of the present study was to determine patient-related predictive factors associated with the need for surgery for CD-associated ileocolic strictures after technically successful EBD.
Methods: All original studies published before December 2023 that reported the outcomes of patients treated with EBD for ileocolic strictures secondary to CD and described follow-up for at least 1 year were included. The difference in risk of needing surgery was calculated for 8 different patient characteristics (Sex, smoking habit, previous surgery, biologic therapy, steroids, immunosuppressors, nature of the stricture, and endoscopic disease activity).
Results: There were significant differences in the risk of needing surgery after EBD among patients who underwent surgery and patients without a history of surgery (RD: -0.20 [-0.31, -0.08]), patients with endoscopic mucosal activity and patients in remission at the time of EBD (RD: 0.19 [0.04, 0.34]), patients using biologics at the time of EBD and patients not using biologics (RD: -0.09 [-0.16, -0.03]), and patients using steroids and those not using steroids at the time of EBD (RD: 0.16 [0.07, 0.26]).
Conclusions: The use of biologics and endoscopic disease remission at the time of EBD were protective factors against the need for surgery. No previous surgery or use of steroids at the time of EBD was associated with the need for surgery during follow-up.