Bypass is associated with lower treatment failure than stricturoplasty in duodenal Crohn's disease: a systematic review with pairwise and network meta-analyses.

BACKGROUND

Crohn's disease (CD) of the duodenum is uncommon, and the goal of treatment is often avoidance of surgery. However, as many as one-third of patients with CD will eventually require surgery for their disease. This study aimed to compare the outcomes and safety of surgical treatments of duodenal CD.

METHODS

In this meta-analysis, a search was conducted for studies that reported outcomes of surgical treatment of duodenal CD. The primary outcome was treatment failure. The secondary outcomes were postoperative complications and reoperation rate.

RESULTS

A total of 10 studies that included 325 patients with predominately stricturing duodenal CD published between 1970 and 2023 were included. Bypass was the surgical treatment for 155 patients (68.6%), followed by stricturoplasty (21.7%) and resection (8.4%). Pairwise meta-analyses revealed that the only significant finding was a lower rate of treatment failure in favor of bypass compared with stricturoplasty (odds ratio [OR], 0.41 [95% CI, 0.18-0.95]; P =.038), with similar odds of complications and reoperation among the 3 operations. In the network meta-analysis, bypass ranked the best with the lowest failure, complication, and reoperation rates. Stricturoplasty had a significantly higher rate of failure than bypass (OR, 2.51 [95% CI, 1.10-5.27]; P =.028).

CONCLUSION

Among the 3 procedures, surgical bypass ranked the best with the lowest failure, complications, and reoperation rates. Although bypass was associated with a lower failure rate than stricturoplasty, both procedures were associated with similar complication and reoperation rates. Based upon this review, surgical bypass is a safe and effective option for the treatment of stricturing duodenal CD.