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Войти в исследования Surgical endoscopy · 2026
Utility of endoscopic ileocecal valve-plasty for Crohn's disease: a propensity-matched retrospective study.
СтатьяНазвание и аннотация: Перевод в очереди
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Lu Yi, Zhang Qi, Yang Ting, Qi LiLi, Yang Tao, Huang Lingyu, Deng Jun, Zhi Min, Sun Jiachen
Аннотация
BACKGROUND AND STUDY AIMS: Ileocecal valve (ICV) strictures complicated by pseudopolyps are sometimes endoscopically inaccessible in Crohn's disease (CD). We previously proposed "ileocecal valve-plasty" (ICVP) that first resects obstructing polypoid hyperplasia to expose the orifice. This propensity-matched, retrospective study compared the efficacy and safety of ICVP with traditional endoscopic balloon dilation/stricturotomy alone.
PATIENTS AND METHODS: CD patients with fibrotic ICV stricture receiving endotherapy were enrolled (from 2014 to 2024), and divided into two groups based on their treatments. Primary outcome was stricture-free survival (SFS); secondary outcomes were technical success, adverse events and surgery rate.
RESULTS: A total of 78 patients with fibrotic ICV strictures were enrolled. After match, 34 patients (mean age 27.8 ± 6.8 years, 28 males) were enrolled, and each group had 17 patients. The mean length of the stricture was longer in the ICVP group (21.8 ± 5.0 vs. 17.4 ± 6.4 mm, P = 0.032). The technical success rate was 94.1% in both groups. Four patients in the ICVP group had delayed hemorrhage and needed endoscopic hemostasis. During a median follow-up of 131 weeks, the SFS had no significant differences between the two groups (P = 0.294). The 1-year SFS in the ICVP and the control group was 40 and 43.2%, respectively. One patient in the ICVP group received ileocecal resection due to stricture. Multivariate analysis identified penetrating behavior, and stricture diameter ≤ 3 mm as independent risk factors for restenosis.
CONCLUSIONS: ICVP safely converts anatomically unfavorable strictures into endoscopically treatable lesions, which might help in postponing or averting surgery. Prospective multicentered validation with risk stratification is warranted.
PATIENTS AND METHODS: CD patients with fibrotic ICV stricture receiving endotherapy were enrolled (from 2014 to 2024), and divided into two groups based on their treatments. Primary outcome was stricture-free survival (SFS); secondary outcomes were technical success, adverse events and surgery rate.
RESULTS: A total of 78 patients with fibrotic ICV strictures were enrolled. After match, 34 patients (mean age 27.8 ± 6.8 years, 28 males) were enrolled, and each group had 17 patients. The mean length of the stricture was longer in the ICVP group (21.8 ± 5.0 vs. 17.4 ± 6.4 mm, P = 0.032). The technical success rate was 94.1% in both groups. Four patients in the ICVP group had delayed hemorrhage and needed endoscopic hemostasis. During a median follow-up of 131 weeks, the SFS had no significant differences between the two groups (P = 0.294). The 1-year SFS in the ICVP and the control group was 40 and 43.2%, respectively. One patient in the ICVP group received ileocecal resection due to stricture. Multivariate analysis identified penetrating behavior, and stricture diameter ≤ 3 mm as independent risk factors for restenosis.
CONCLUSIONS: ICVP safely converts anatomically unfavorable strictures into endoscopically treatable lesions, which might help in postponing or averting surgery. Prospective multicentered validation with risk stratification is warranted.