重复内窥镜扩张术和针刀狭窄切开术治疗克罗恩病狭窄。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Gastrointestinal endoscopy Pub Date : 2025-01-01 DOI:10.1016/j.gie.2024.09.031

Julien D. Schulberg PhD , Amy L. Hamilton PhD , Emily K. Wright PhD , Bronte A. Holt PhD , Tom R. Sutherland MBBS , Alyson L. Ross RN , Sara Vogrin MBiostat , Michael A. Kamm MD, PhD

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引用次数: 0

摘要

背景和目的：克罗恩病狭窄通常采用单次内镜下球囊扩张术（EBD）治疗。我们推测，重复 EBD 和针刀狭窄切开术（NKSt），再加上强效药物治疗控制炎症，可能会更有效。方法：21 名无症状狭窄患者被随机分配接受单次 EBD 或 3 次球囊扩张（间隔 3 周）和/或 NKSt 的强化治疗。结果：21 名患者中，5 人中有 2 人（40%）接受了单次 EBD，12/16 [72%] 接受了强化治疗，症状有所改善（OR 4.49 [95% CI 0.54 - 37.4]；P = 0.164）。11名患者接受了>1次EBD治疗，但没有接受NKSt治疗，5名患者接受了≥1次NKSt治疗：结论：采用重复扩张术或狭窄切开术治疗克罗恩病狭窄是可行、安全的，并可改善狭窄的预后。同时加强药物治疗以消除炎症也能改善预后。

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Repeated endoscopic dilation and needle-knife stricturotomy for Crohn’s disease strictures

Background and Aims

Crohn’s disease strictures are usually treated by a single endoscopic balloon dilation (EBD). We postulated repeat EBD and needle-knife stricturotomy (NKSt), together with inflammation controlled by intense drug therapy, may be more effective.

Methods

Twenty-one patients with symptomatic strictures were randomized to a single EBD or intensive treatment with 3 balloon dilations 3 weeks apart and/or NKSt.

Results

Of 21 patients, 2 of 5 (40%) undergoing a single EBD and 12 of 16 (72%) undergoing intensive treatment had symptom improvement (odds ratio, 4.49; 95% confidence interval, .54-37.4; P = .164). Eleven patients received >1 EBD without NKSt and 5 underwent ≥1 NKSt. NKSt-treated patients and those with concurrent intensified drug treatment had the best outcomes.

Conclusions

Treatment for Crohn’s disease strictures with repeat dilations or stricturotomy is feasible and safe and may improve stricture outcomes. Concurrent intensified drug treatment to eliminate inflammation is also associated with improved outcomes. (Clinical trial registration number: NCT03222011.)

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.

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