炎症性肠病狭窄、瘘和脓肿内镜治疗的系统评价

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Insights Pub Date : 2023-02-13 DOI:10.3390/gastroent14010006
P. Pal, Swathi Kanaganti, R. Banerjee, M. Ramchandani, Z. Nabi, D. Reddy, M. Tandan
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引用次数: 1

摘要

背景:介入性炎症性肠病(IIBD)治疗可以在炎症性肠病(IBD)相关狭窄/瘘/脓肿延迟或避免侵入性手术中发挥关键作用。方法:通过检索Pubmed, Medline和Embase,纳入2002年至2022年12月期间有关IIBD治疗狭窄/瘘管/脓肿的112项研究,重点关注技术/临床成功,复发,再干预和并发症。结果:IIBD治疗狭窄包括内镜下球囊扩张(EBD)、内镜下狭窄切开术(ES)和自膨胀金属支架(SEMS)置入。EBD是短期狭窄的主要治疗方法,而ES和SEMS可用于难治性狭窄。ES的远期疗效高于EBD。SEMS不如EBD,尽管它可以用于长,难治的狭窄。瘘管治疗包括内镜下切开引流(肛周瘘)/内镜下缝合(简单、低瘘)和内镜下超声引导引流(盆腔脓肿)。瘘管切开术可用于短的、浅表的、单道的肠瘘。内镜下注射填充剂(瘘管塞/胶/干细胞)是可行的,但耐久性尚不清楚。对于新生/肠至空心器官瘘管,应避免使用镜外夹(OTSC)、缝合和SEMS等内镜闭合疗法。结论:IIBD治疗有可能作为药物和手术治疗之间的桥梁,适当选择ibd相关的狭窄/瘘/脓肿,尽管未来的对照研究是必要的。
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Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease
Background: Interventional inflammatory bowel disease (IIBD) therapies can play a key role in inflammatory bowel disease (IBD) related stricture/fistula/abscess deferring or avoiding invasive surgery. Methods: A total of 112 studies pertaining to IIBD therapy for strictures/fistula/abscess between 2002 and December 2022 were included by searching Pubmed, Medline and Embase with a focus on technical/clinical success, recurrence, re-intervention and complications. Results: IIBD therapy for strictures include endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES) and self-expanding metal stent (SEMS) placement. EBD is the primary therapy for short strictures while ES and SEMS can be used for refractory strictures. ES has higher long-term efficacy than EBD. SEMS is inferior to EBD although it can be useful in long, refractory strictures. Fistula therapy includes endoscopic incision and drainage (perianal fistula)/endoscopic seton (simple, low fistula) and endoscopic ultrasound-guided drainage (pelvic abscess). Fistulotomy can be done for short, superficial, single tract, bowel-bowel fistula. Endoscopic injection of filling agents (fistula plug/glue/stem cell) is feasible although durability is unknown. Endoscopic closure therapies like over-the-scope clips (OTSC), suturing and SEMS should be avoided for de-novo/bowel to hollow organ fistulas. Conclusion: IIBD therapies have the potential to act as a bridge between medical and surgical therapy for properly selected IBD-related stricture/fistula/abscess although future controlled studies are warranted.
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来源期刊
Gastroenterology Insights
Gastroenterology Insights GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.80
自引率
3.40%
发文量
35
审稿时长
10 weeks
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