BACKGROUND Crohn's disease(CD)frequently leads to intestinal strictures,which pose significant challenges due to their complexity and limited treatment options.While medications can address inflammatory strictures...BACKGROUND Crohn's disease(CD)frequently leads to intestinal strictures,which pose significant challenges due to their complexity and limited treatment options.While medications can address inflammatory strictures,they are largely ineffective for fibrotic and mixed strictures,often necessitating surgical intervention.However,surgery carries considerable risks,including bleeding,infection,anastomotic leaks,and postoperative restricture formation.Endoscopic treatment,particularly endoscopic stricturotomy,offers a minimally invasive alternative that bridges the gap between medication and surgery.AIM To investigate the safety and efficacy of stricturotomy under single-balloon enteroscopy in stricturing CD.METHODS Patients diagnosed with stricturing CD at The First People's Hospital of Changzhou from June 2020 to April 2024 were enrolled and underwent endoscopic stricturotomy(ES).Relevant clinical data of patients were collected retrospectively.Outcomes included success rate,remission time,complications,and follow-up interventions.This observational study was followed up postoperatively to observe patient remission and recurrence rates.RESULTS Seventeen endoscopic strictures were created in 11 patients,achieving a 100%immediate success rate without any serious complications.During the follow-up period,stricture recurrence was observed in two patients,resulting in an endoscopic reintervention rate of 18.2%.Additionally,two patients required subsequent surgical intervention,with a surgical treatment rate of 18.2%.One patient experienced bowel obstruction 18 months post-ES and was successfully managed with conservative treatment without surgical intervention.The remission duration after the initial ES treatment was 10.1±8.2 months,with a median remission time of 10 months.CONCLUSION ES is a safe and effective treatment for CD-related strictures and warrants further clinical promotion and application.展开更多
Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstr...Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstructing the enteral nutrition pathway in patients with gastrointestinal strictures.Endoscopic stricturotomy is a safe and effective way to open the nutritional pathway,especially for those with anatomic stricture length<1 cm,and can be used either as the primary choice of treatment for patients with gastrointestinal stricture or as rescue therapy for refractory cases.Endoscopic stricturotomy can be executed with radial incision and cutting or circular incision and cutting.After the stricturotomy,other endoscopic treatments,such as endoscopic balloon dilation,stent implantation,and intra-lesional injection of steroids,can be used to prevent the development of re-stricture.This article reviews the clinical experiences with endoscopic stricturotomy for opening strictures along the enteral nutrition pathway in patients with gastrointestinal strictures.展开更多
Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not bee...Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not been described.The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures.Methods:Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted.The primary outcomes were surgery-free survival and procedure-related complications.Results:A total of 49 IBD and 15 non-IBD patients were included in this study.The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches.Underlying diseases in the non-IBD group included colorectal cancer(n=7),diverticulitis(n=5),large bowel prolapse(n=2),and constipation(n=1).Immediate technical success was achieved in all patients in both groups.Bleeding complications occurred on five occasions(4.7%per procedure)in the IBD group,while no complication occurred in the non-IBD group(P=0.20).Stricture improvement on follow-up endoscopy was found in 10(20.4%)and 5(33.3%)patients in the IBD and non-IBD groups,respectively(P=0.32).Six(12.2%)patients in the IBD group and four(26.7%)patients in the non-IBD group eventually required stricture-related surgery(P=0.23).IBD patients appeared to have a higher tendency formaintaining surgery-free after the procedure than non-IBD patients(P=0.08).Conclusions:Endoscopic stricturotomy was shown to have comparable outcomes,though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.展开更多
Background:Stricture is a common presentation of Crohn’s disease with the site of prevalence being the distal ileum.This study aimed to compare the efficacy and safety of patients with primary distal ileum stricture ...Background:Stricture is a common presentation of Crohn’s disease with the site of prevalence being the distal ileum.This study aimed to compare the efficacy and safety of patients with primary distal ileum stricture treated with endoscopic stricturotomy(ESt)vs ileo-colonic resection(ICR).Methods:All consecutive patients with primary distal ileum stricture that were treated with ESt and/or ICR were extracted from the interventional inflammatory bowel disease(i-IBD)unit from 2001 to 2016.All patients with a stricture>5cmor those with anastomotic strictures were excluded from the study.The primary outcomes were surgery-free survival and post-procedural complications.Results:A total of 13 patients receiving ESt and 32 patients receiving ICR were included in this study.Although the length of the stricture is comparable between the two groups(2.460.9 vs 3.061.1 cm,P=0.17),patients who received surgery had a more complicated obstruction presented by the high pre-stenosis proximal dilation rate(67.7%vs 9.1%,P=0.001).All patients in both groups achieved immediate technical success after treatment.Themedian follow-up durations were 1.8 and 1.5 years in the ESt and ICR groups,respectively.The subsequent surgery rates were similar between the two groups(15.4%vs 18.8%,P=0.79)and the overall surgery-free survival was also comparable between the two groups(P=0.98).Post-procedural adverse events were seen in 2/29 ESt procedures(6.9%per procedure)and 8/32(25.0%)patients receiving ICR(P=0.05).Conclusions:ESt achieved comparable stricture-related surgery-free survival as ICR,while ESt had a numerically lower post-operative complication rate.展开更多
We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology.In this article,the authors reported a novel technique for re-establishing luminal continuity in a completely ...We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology.In this article,the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes,one for radial electrical incision and the other serving as a guide light.However,this technique can be applied only in selected cases.Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction,by reviewing the available literature,we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.展开更多
Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical tre...Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical treatments.Currently,the main applications of interventional IBD are(i)strictures;(ii)fistulas and abscesses;(iii)bleeding lesions,bezoars,foreign bodies,and polyps;(iv)post-operative complications such as acute and chronic anastomotic leaks;and(v)colitis-associated neoplasia.The endoscopic treatment modalities include balloon dilation,stricturotomy,strictureplasty,fistulotomy,incision and drainage(of fistula and abscess),sinusotomy,septectomy,banding ligation,clipping,polypectomy,endoscopic mucosal resection,and endoscopic submucosal dissection.The field of interventional IBD is evolving with a better understanding of the underlying disease process,advances in endoscopic technology,and interest and proper training of next-generation IBD interventionalists.展开更多
Background:Strictures are a common complication after ileal pouch surgery with the most common locations being at the anasto-mosis,pouch inlet,and stoma closure site.No previous literature has described endoscopic the...Background:Strictures are a common complication after ileal pouch surgery with the most common locations being at the anasto-mosis,pouch inlet,and stoma closure site.No previous literature has described endoscopic therapy of stoma site stricture.This study aimed to assess the safety and efficacy of endoscopic therapy in the treatment of stoma closure site strictures.Method:Patients diagnosed with stoma closure site strictures following ileal pouch surgery who underwent endoscopic treatment at the Center for Colorectal Diseases,Inflammatory Bowel Disease(IBD),and Ileal Pouch between 2018 and 2022 were analysed.Primary outcomes(technical success and surgery-free survival)were compared between endoscopic balloon dilation(EBD)and stricturotomy and/or strictureplasty.Results:A total of 30 consecutive eligible patients were analysed.Most patients were female(66.7%)and most patients were diag-nosed with IBD(93.3%).Twenty patients(66.7%)had end-to-end anastomosis.A total of 52 procedures were performed,with EBD in 16(30.8%)and stricturotomy and/or strictureplasty in 36(69.2%).The mean stricture length was 1.7±1.0 cm.Immediate technical success was achieved in 47 of 52 interventions(90.4%).During a mean follow-up of 12.7±9.9 months,none of the patients underwent surgical intervention for the stricture.Fourteen(46.7%)required endoscopic re-intervention for their strictures with an interval be-tween index and re-interventional pouchoscopy of 8.8±6.3 months.Post-procedural complications were reported in 2(6.7%)with bleeding and none with perforation.Upon follow-up,20(66.7%)patients reported improvement in their symptoms.Conclusion:EBD and endoscopic stricturotomy and/or strictureplasty are safe and effective in treating stoma closure site strictures in patients with ileal pouches,providing symptomatic relief in most patients as well as avoiding surgery.展开更多
Interventional endoscopy can play a key role in the multidisciplinary management of complex inflammatory bowel disease(IBD)as an adjunct to medical and surgical therapy.The primary role of interventional IBD(IIBD)incl...Interventional endoscopy can play a key role in the multidisciplinary management of complex inflammatory bowel disease(IBD)as an adjunct to medical and surgical therapy.The primary role of interventional IBD(IIBD)includes the treatment of Crohn’s disease-related stricture,fistula,and abscess.Endoscopic balloon dilation(EBD),endoscopic stricturotomy,and placement of endoscopic stents are different forms of endoscopic stricture therapy.EBD is the most widely used therapy whereas endoscopic stricturotomy has higher long-term efficacy than EBD.Fully covered and partially covered self-expanding metal stents are useful in long and refractory strictures whereas lumen-apposing metal stents can be used in short,and anastomotic strictures.Endoscopic fistula/abscess therapy includes endoscopic fistulotomy,seton placement,endoscopic ultrasound-guided drainage of rectal/pelvic abscess,and endoscopic injection of filling agents(fistula plug/glue/stem cell).Endoscopic seton placement and fistulotomy are mainly feasible in short,superficial,single tract fistula and in those with prior surgical seton placement.Similarly,endoscopic fistulotomy is usually feasible in short,superficial,single-tract fistula.Endoscopic closure therapies like over-the-scope clips,suturing,and self-expanding metal stent should be avoided for de novo/bowel to hollow organ fistulas.Other indications include management of postoperative complications in IBD such as management of surgical leaks and complications of pouchitis in ulcerative colitis.Additional indications include endoscopic resection of ulcerative colitis-associated neoplasia(by endoscopic mucosal resection,endoscopic submucosal dissection,and endoscopic full-thickness resection),retrieval of retained capsule endoscope,and control of bleeding.IIBD therapies can potentially act as a bridge between medical and surgical therapy for properly selected IBD patients.展开更多
文摘BACKGROUND Crohn's disease(CD)frequently leads to intestinal strictures,which pose significant challenges due to their complexity and limited treatment options.While medications can address inflammatory strictures,they are largely ineffective for fibrotic and mixed strictures,often necessitating surgical intervention.However,surgery carries considerable risks,including bleeding,infection,anastomotic leaks,and postoperative restricture formation.Endoscopic treatment,particularly endoscopic stricturotomy,offers a minimally invasive alternative that bridges the gap between medication and surgery.AIM To investigate the safety and efficacy of stricturotomy under single-balloon enteroscopy in stricturing CD.METHODS Patients diagnosed with stricturing CD at The First People's Hospital of Changzhou from June 2020 to April 2024 were enrolled and underwent endoscopic stricturotomy(ES).Relevant clinical data of patients were collected retrospectively.Outcomes included success rate,remission time,complications,and follow-up interventions.This observational study was followed up postoperatively to observe patient remission and recurrence rates.RESULTS Seventeen endoscopic strictures were created in 11 patients,achieving a 100%immediate success rate without any serious complications.During the follow-up period,stricture recurrence was observed in two patients,resulting in an endoscopic reintervention rate of 18.2%.Additionally,two patients required subsequent surgical intervention,with a surgical treatment rate of 18.2%.One patient experienced bowel obstruction 18 months post-ES and was successfully managed with conservative treatment without surgical intervention.The remission duration after the initial ES treatment was 10.1±8.2 months,with a median remission time of 10 months.CONCLUSION ES is a safe and effective treatment for CD-related strictures and warrants further clinical promotion and application.
文摘Benign gastrointestinal stricture significantly restricts enteral nutrition,which directly affects the quality of life of patients.Advances in endoscopic techniques have provided a minimally invasive means of reconstructing the enteral nutrition pathway in patients with gastrointestinal strictures.Endoscopic stricturotomy is a safe and effective way to open the nutritional pathway,especially for those with anatomic stricture length<1 cm,and can be used either as the primary choice of treatment for patients with gastrointestinal stricture or as rescue therapy for refractory cases.Endoscopic stricturotomy can be executed with radial incision and cutting or circular incision and cutting.After the stricturotomy,other endoscopic treatments,such as endoscopic balloon dilation,stent implantation,and intra-lesional injection of steroids,can be used to prevent the development of re-stricture.This article reviews the clinical experiences with endoscopic stricturotomy for opening strictures along the enteral nutrition pathway in patients with gastrointestinal strictures.
基金Dr Bo Shen is supported by the Ed and Joey Story Endowed ChairThis study was presented as a poster at the American College of Gastroenterology(October 2017,Orlando,Florida).
文摘Backgrounds:Endoscopic stricturotomy(ESt)has been shown to be effective in treating inflammatory bowel disease(IBD)-associated anastomotic strictures.However,the outcome of ESt in benign,non-IBD conditions has not been described.The aim of this study was to evaluate the outcome of ESt in the management of IBD and non-IBD-associated strictures.Methods:Data of all consecutive IBD and non-IBD patients with benign anastomotic strictures treated with ESt from 2009 to 2016 were extracted.The primary outcomes were surgery-free survival and procedure-related complications.Results:A total of 49 IBD and 15 non-IBD patients were included in this study.The IBD group included 25 patients with Crohn’s disease and 24 with ulcerative colitis and ileal pouches.Underlying diseases in the non-IBD group included colorectal cancer(n=7),diverticulitis(n=5),large bowel prolapse(n=2),and constipation(n=1).Immediate technical success was achieved in all patients in both groups.Bleeding complications occurred on five occasions(4.7%per procedure)in the IBD group,while no complication occurred in the non-IBD group(P=0.20).Stricture improvement on follow-up endoscopy was found in 10(20.4%)and 5(33.3%)patients in the IBD and non-IBD groups,respectively(P=0.32).Six(12.2%)patients in the IBD group and four(26.7%)patients in the non-IBD group eventually required stricture-related surgery(P=0.23).IBD patients appeared to have a higher tendency formaintaining surgery-free after the procedure than non-IBD patients(P=0.08).Conclusions:Endoscopic stricturotomy was shown to have comparable outcomes,though non-IBD patients seem to have a higher need for subsequent surgery but a lower complication rate than IBD patients.
文摘Background:Stricture is a common presentation of Crohn’s disease with the site of prevalence being the distal ileum.This study aimed to compare the efficacy and safety of patients with primary distal ileum stricture treated with endoscopic stricturotomy(ESt)vs ileo-colonic resection(ICR).Methods:All consecutive patients with primary distal ileum stricture that were treated with ESt and/or ICR were extracted from the interventional inflammatory bowel disease(i-IBD)unit from 2001 to 2016.All patients with a stricture>5cmor those with anastomotic strictures were excluded from the study.The primary outcomes were surgery-free survival and post-procedural complications.Results:A total of 13 patients receiving ESt and 32 patients receiving ICR were included in this study.Although the length of the stricture is comparable between the two groups(2.460.9 vs 3.061.1 cm,P=0.17),patients who received surgery had a more complicated obstruction presented by the high pre-stenosis proximal dilation rate(67.7%vs 9.1%,P=0.001).All patients in both groups achieved immediate technical success after treatment.Themedian follow-up durations were 1.8 and 1.5 years in the ESt and ICR groups,respectively.The subsequent surgery rates were similar between the two groups(15.4%vs 18.8%,P=0.79)and the overall surgery-free survival was also comparable between the two groups(P=0.98).Post-procedural adverse events were seen in 2/29 ESt procedures(6.9%per procedure)and 8/32(25.0%)patients receiving ICR(P=0.05).Conclusions:ESt achieved comparable stricture-related surgery-free survival as ICR,while ESt had a numerically lower post-operative complication rate.
文摘We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology.In this article,the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes,one for radial electrical incision and the other serving as a guide light.However,this technique can be applied only in selected cases.Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction,by reviewing the available literature,we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.
文摘Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical treatments.Currently,the main applications of interventional IBD are(i)strictures;(ii)fistulas and abscesses;(iii)bleeding lesions,bezoars,foreign bodies,and polyps;(iv)post-operative complications such as acute and chronic anastomotic leaks;and(v)colitis-associated neoplasia.The endoscopic treatment modalities include balloon dilation,stricturotomy,strictureplasty,fistulotomy,incision and drainage(of fistula and abscess),sinusotomy,septectomy,banding ligation,clipping,polypectomy,endoscopic mucosal resection,and endoscopic submucosal dissection.The field of interventional IBD is evolving with a better understanding of the underlying disease process,advances in endoscopic technology,and interest and proper training of next-generation IBD interventionalists.
文摘Background:Strictures are a common complication after ileal pouch surgery with the most common locations being at the anasto-mosis,pouch inlet,and stoma closure site.No previous literature has described endoscopic therapy of stoma site stricture.This study aimed to assess the safety and efficacy of endoscopic therapy in the treatment of stoma closure site strictures.Method:Patients diagnosed with stoma closure site strictures following ileal pouch surgery who underwent endoscopic treatment at the Center for Colorectal Diseases,Inflammatory Bowel Disease(IBD),and Ileal Pouch between 2018 and 2022 were analysed.Primary outcomes(technical success and surgery-free survival)were compared between endoscopic balloon dilation(EBD)and stricturotomy and/or strictureplasty.Results:A total of 30 consecutive eligible patients were analysed.Most patients were female(66.7%)and most patients were diag-nosed with IBD(93.3%).Twenty patients(66.7%)had end-to-end anastomosis.A total of 52 procedures were performed,with EBD in 16(30.8%)and stricturotomy and/or strictureplasty in 36(69.2%).The mean stricture length was 1.7±1.0 cm.Immediate technical success was achieved in 47 of 52 interventions(90.4%).During a mean follow-up of 12.7±9.9 months,none of the patients underwent surgical intervention for the stricture.Fourteen(46.7%)required endoscopic re-intervention for their strictures with an interval be-tween index and re-interventional pouchoscopy of 8.8±6.3 months.Post-procedural complications were reported in 2(6.7%)with bleeding and none with perforation.Upon follow-up,20(66.7%)patients reported improvement in their symptoms.Conclusion:EBD and endoscopic stricturotomy and/or strictureplasty are safe and effective in treating stoma closure site strictures in patients with ileal pouches,providing symptomatic relief in most patients as well as avoiding surgery.
文摘Interventional endoscopy can play a key role in the multidisciplinary management of complex inflammatory bowel disease(IBD)as an adjunct to medical and surgical therapy.The primary role of interventional IBD(IIBD)includes the treatment of Crohn’s disease-related stricture,fistula,and abscess.Endoscopic balloon dilation(EBD),endoscopic stricturotomy,and placement of endoscopic stents are different forms of endoscopic stricture therapy.EBD is the most widely used therapy whereas endoscopic stricturotomy has higher long-term efficacy than EBD.Fully covered and partially covered self-expanding metal stents are useful in long and refractory strictures whereas lumen-apposing metal stents can be used in short,and anastomotic strictures.Endoscopic fistula/abscess therapy includes endoscopic fistulotomy,seton placement,endoscopic ultrasound-guided drainage of rectal/pelvic abscess,and endoscopic injection of filling agents(fistula plug/glue/stem cell).Endoscopic seton placement and fistulotomy are mainly feasible in short,superficial,single tract fistula and in those with prior surgical seton placement.Similarly,endoscopic fistulotomy is usually feasible in short,superficial,single-tract fistula.Endoscopic closure therapies like over-the-scope clips,suturing,and self-expanding metal stent should be avoided for de novo/bowel to hollow organ fistulas.Other indications include management of postoperative complications in IBD such as management of surgical leaks and complications of pouchitis in ulcerative colitis.Additional indications include endoscopic resection of ulcerative colitis-associated neoplasia(by endoscopic mucosal resection,endoscopic submucosal dissection,and endoscopic full-thickness resection),retrieval of retained capsule endoscope,and control of bleeding.IIBD therapies can potentially act as a bridge between medical and surgical therapy for properly selected IBD patients.
