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COMPARISON OF ENDOSCOPIC AND RADIOLOGICAL RESULTS BETWEEN STRICTUREPLASTY AND INTESTINAL RESECTION IN PATIENTS WITH SMALL BOWEL STRICTURING CROHN'S DISEASE
Xi Zhang
*1, Yi Li
2, Weiming Zhu
31Southeast University, Nanjing, Jiangsu, China; 2General Hospital of Eastern Theatre Command Department of General Surgery, Nanjing, Jiangsu, China; 3Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
Background: The efficacy of strictureplasty as an alternative to intestinal resection in Crohn's disease (CD) remains contentious. This study aims to compare the endoscopic and radiological outcomes of strictureplasty versus intestinal resection with anastomosis in patients with CD.
Methods: A retrospective cohort study was conducted to analyze the medical records of patients who underwent surgical intervention for CD at our center. Cohort A included patients who underwent strictureplasty, using either the Heineke-Mikulicz (H-M) or Finney technique. Cohort B comprised patients who underwent only intestinal resection for stricturing CD. Lon-term postoperative outcomes were assessed through computed tomography enterography (CTE) and enteroscopy. Endoscopic recurrence was evaluated using the Simplified Endoscopic Score for Crohn's Disease (SES-CD), focusing exclusively on the ileum (score range: 0–12). Recurrence was defined as an SES-CD score of ?3 or the need for a change in the therapeutic regimen. Two independent, experienced radiologists reviewed CTE parameters, including mucosal enhancement, mural stratification, wall enhancement, comb sign, lymphadenopathy, thick non-enhancing wall, bowel wall thickness, luminal diameter, and the upstream lumen.
Results: A total of 60 patients (30 in each cohort) were included in the analysis. The median follow-up duration was comparable between Cohort A and Cohort B (14 vs. 11 months). The two groups were matched in terms of Montreal classification (all
P > 0.05). The median postoperative length of stay was 9.5 days for Cohort A and 7 days for Cohort B (
P = 0.334). No significant differences were observed in the overall incidence of short-term postoperative complications between the two groups (
P = 0.438), with postoperative ileus being the most common cause for delayed discharge. More patients in Cohort B received biologic therapy postoperatively (13 vs. 23,
P=0.008). Endoscopic assessment at a median follow-up of 8 months revealed submucosal healing at the surgical site in 38 patients (63%). 7 patients in Cohort A developed ulceration or stenosis at the strictureplasty site, compared to 15 patients occurring near the anastomotic site in Cohort B (
P = 0.030). However, at the final follow-up, endoscopic recurrence requiring escalation of medication was observed in 14 patients in Cohort A and 17 patients in Cohort B (
P=0.47, fig. 1). In addition, radiological evaluation using CTE showed no significant differences between the groups in bowel wall thickness (5.60 vs. 6.15 mm,
P > 0.1) or lumen diameter (12.9 vs. 12.0 mm,
P = 0.083).
Conclusion: Mucosal and transmural healing at the site of strictureplasty was promising one year after surgery compared with bowel resection with anastomosis. Strictureplasty did not appear to increase the risk of drug escalation compared to resection with anastomosis.
Fig.1 Comparison of drug escalation due to postoperative recurrence between the two cohorts in Kaplan-Meier survival curves.
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