Navigating Narrow Paths, Efficacy & Safety of Endoscopic Stricturotomy in Inflammatory Bowel Disease Patients: A Systematic Review & Meta-Analysis

Document Type

Abstract

Publication Date

6-1-2024

Abstract

Institutions: Saint Peter's University Hospital, USA; Shree Bhausaheb Hire Government Medical College, India; Reading Hospital, USA; The University of Texas Health Science Center at San Antonio, USA; University of Connecticut, USA; Rochester General Health System, USA; East Tennessee State University, USA; Centura Health at Home, USA; Orlando Gastroenterology PA, USA. Disclosure compliance: I understand. Participant disclosure: Vishali Moond: NO financial relationship with a commercial interest; Archit Garg: NO financial relationship with a commercial interest; Ameya Kasture: NO financial relationship with a commercial interest; Priyadarshini Loganathan: NO financial relationship with a commercial interest; Ruchir Paladiya: NO financial relationship with a commercial interest; Sheza Malik: NO financial relationship with a commercial interest; Sandesh Parajuli: NO financial relationship with a commercial interest; Hassam Ali: NO financial relationship with a commercial interest; Arkady Broder: NO financial relationship with a commercial interest; Babu Mohan: NO financial relationship with a commercial interest; Douglas Adler: Consulting: Boston Scientific, Olympus; Speaking and Teaching: Abbvie. Background & Aims: Endoscopy stricturotomy has gathered attention in the treatment of strictures in patients with inflammatory bowel disease (IBD) and seems to be a promising novel approach. However, the clinical outcomes of endoscopic strictuorotomy have not been well-established due to small-sized studies. We performed a pooled analysis of the efficacy and safety of endoscopic stricturotomy in patients with IBD. Methods: We searched multiple electronic databases including Medline, Web of Science, CochranePubmed, and Embase and conference proceedings from inception through October 2023 articles reporting outcomes following endoscopic stricturotomy for benign lower gastrointestinal stricturing disease. Two reviewers independently conducted screening, full-text review, and data extraction according to PRISMA guidelines. The clinical outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I2 statistics. Results: We analyzed 18 studies including 4 prospective and 14 retrospective studies involving 637 patients (363 males with a mean age of 45 years) and a mean duration follow-up of 574 days. 53% of these patients had Crohn's disease with 85.6% having anastomotic strictures located mostly in the ileocolonic region (26.58%). The median length of the strictures was 1.80 cm. The pooled technical success rate of endoscopic stricturotomy was 95.7 % (CI 92.7 - 97.5%; I2 =0%) and the pooled therapeutic success rate was 67.4% (CI 49.9 - 81.1%; I2 = 72.7%). The pooled major complications per procedure were 5.5% (4.2-7.2%; I2 =0%). The risk of bleeding associated per procedure was 4.8% (3.6-6.5%; I2 =0%, ) whereas the risk of perforation associated per procedure was 1.9% (1.1-3.3%; I2 =0%). There were no reported deaths with endoscopic stricturotomy. We found that the pooled rate of patients who required repeat stricturotomy was 39.9% (11.6 -75.8%; I2 =91.8%) whereas the pooled rate of patients who required repeat surgery was 16.7% (7.5 -33.1%; I2 =87%). Conclusions: On meta-analysis, endoscopic stricturotomy demonstrated an excellent pooled technical success rate of 95.7%. However, the pooled clinical success was modest at 67.4%. Pooled adverse events suggest that the procedure is safe with a low risk of perforation at 1.9%. Overall, the results of this analysis seem in favour of endoscopic stricturotomy in patients with IBD. However, in light of modest clinical success and 39.9% of patients requiring repeat stricturotomies, future studies are warranted to ascertain the right patient cohort that would benefit the most.

Publication Title

Gastrointestinal Endoscopy

Volume

99

Issue

6 Supplement

First Page

AB1127

Last Page

AB1128

Comments

Digestive Disease Week held 2024-05-18 to 2024-05-21 in Washington, USA.

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