دورية أكاديمية
Clinical outcomes of serial endoscopic balloon dilation for duodenal Crohn's disease-associated strictures.
| العنوان: | Clinical outcomes of serial endoscopic balloon dilation for duodenal Crohn's disease-associated strictures. |
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| المؤلفون: | Zhang J; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Qian X; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Zhu L; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Da B; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Zhao X; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., He Q; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Wang L; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Li Y; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China., Wang Z; Research Institute of General Surgery, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China. wzmdoc@163.com. |
| المصدر: | Surgical endoscopy [Surg Endosc] 2024 Aug; Vol. 38 (8), pp. 4512-4520. Date of Electronic Publication: 2024 Jun 24. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 1992- : New York : Springer Original Publication: [Berlin] : Springer International, c1987- |
| مواضيع طبية MeSH: | Crohn Disease*/complications , Crohn Disease*/therapy , Dilatation*/methods , Dilatation*/instrumentation, Humans ; Female ; Male ; Adult ; Middle Aged ; Treatment Outcome ; Constriction, Pathologic/etiology ; Constriction, Pathologic/surgery ; Young Adult ; Retrospective Studies ; Duodenal Obstruction/etiology ; Duodenal Obstruction/therapy ; Duodenal Obstruction/surgery ; Adolescent ; Duodenal Diseases/therapy ; Duodenal Diseases/etiology ; Duodenal Diseases/surgery |
| مستخلص: | Background: Endoscopic balloon dilation (EBD) is a safe and effective treatment for Crohn's disease (CD)-associated strictures. However, serial EBDs have rarely been reported. This study aimed to evaluate the efficacy and safety of serial EBDs for treating CD-associated duodenal strictures compared with intermittent EBDs. Methods: Patients with CD-associated duodenal strictures who underwent EBD were recruited. The clinical data, stricture characteristics, number of EBDs, dilation diameter, complications, surgical interventions, and follow-up periods were recorded. Patients were divided into a serial dilation group and an intermittent dilation group to analyze the differences in safety and efficacy. Results: Forty-five patients with duodenal CD-associated strictures underwent a total of 139 dilations. A total of 23 patients in the serial dilation group underwent 72 dilations, for a median of 3 (range 3 ~ 4) dilations per patient, and 22 patients in the intermittent dilation group underwent 67 dilations, for a median of 3 (range 1 ~ 6) dilations per patient. Technical success was achieved in 97.84% (136/139) of the patients. During the follow-up period, three patients in the intermittent dilation group underwent surgery, and the total clinical efficacy was 93.33% (42/45). No difference in safety or short-term efficacy was noted between the two groups, but serial EBDs exhibited significantly greater clinical efficacy between 6 months and 2 years. No significant difference in recurrence-free survival was observed, but the median longest recurrence-free survival and recurrence-free survival after the last EBD in the serial dilation group were 693 days (range 298 ~ 1381) and 815 days (range 502 ~ 1235), respectively, which were significantly longer than the 415 days (range 35 ~ 1493) and 291 days (range 34 ~ 1493) in the intermittent dilation group (p = 0.013 and p = 0.000, respectively). At the last follow-up, the mean diameter of the duodenal lumen was 1.17 ± 0.07 cm in the serial dilation group, which was greater than the 1.11 ± 0.10 cm in the intermittent dilation group (p = 0.018). We also found that the Simple Endoscopic Score for Crohn's Disease was associated with an increased risk of surgical intervention (HR 2.377, 95% CI 1.125-5.020; p = 0.023) and recurrence at 6 months after the last EBD (HR 0.698, 95% CI 0.511-0.953; p = 0.024), as assessed by univariate analysis. Conclusions: Compared to the intermittent EBDs, serial EBDs for duodenal CD-associated strictures exhibit greater clinical efficacy within two years and could delay stricture recurrence. We suggest that serial EBDs can be a novel option for endoscopic treatment of duodenal CD-associated strictures. (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
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| معلومات مُعتمدة: | 22JCYYZD4 In-hospital Project of Jinling Hospital; CXZX202217 Jiangsu Provincial Medical Innovation Center |
| فهرسة مساهمة: | Keywords: Crohn’s disease (CD); Duodenal CD; Duodenal strictures; Efficacy; Endoscopic balloon dilation (EBD); Serial dilations |
| تواريخ الأحداث: | Date Created: 20240624 Date Completed: 20240730 Latest Revision: 20240730 |
| رمز التحديث: | 20240731 |
| DOI: | 10.1007/s00464-024-10992-8 |
| PMID: | 38914885 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1432-2218 |
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| DOI: | 10.1007/s00464-024-10992-8 |