SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Clinical Gastroenterology and Hepatology
  2018/08  
 
  2018 Aug;16(8):1260-1267.  
  doi: 10.1016/j.cgh.2018.02.035  
 
  Outcomes of Endoscopic Balloon Dilation vs Surgical Resection for Primary Ileocolic Strictures in Patients With Crohn's Disease.  
 
  Lan N, Stocchi L, Ashburn JH, Hull TL, Steele SR, Delaney CP, Shen B  
  https://www.ncbi.nlm.nih.gov/pubmed/29505909  
 
 

Abstract

BACKGROUND & AIMS:

Few studies have compared endoscopic balloon dilation (EBD) with ileocolic resection (ICR) in the treatment of primary ileocolic strictures in patients with Crohn's disease (CD).

METHODS:

We performed a retrospective study to compare postprocedure morbidity and surgery-free survival among 258 patients with primary stricturing ileo(colic) CD (B2, L1, or L3) initially treated with primary EBD (n = 117) or ICR (n = 258) from 2000 through 2016. Patients with penetrating disease were excluded from the study. We performed multivariate analyses to evaluate factors associated with surgery-free survival.

RESULTS:

Postprocedural complications occurred in 4.7% of patients treated with EBD and salvage surgery was required in 44.4% of patients. Factors associated with reduced surgery-free survival among patients who underwent EBD included increased stricture length (hazard ratio, 2.0; 95% CI, 1.3-3.3), ileocolonic vs ileal disease (hazard ratio, 10.9; 95% CI, 2.6-45.4), and decreased interval between EBD procedures (hazard ratio, 1.2; 95% CI, 1.1-1.4). There were no significant differences in sex, age, race, or CD duration between EBD and ICR groups. Patients treated with ICR were associated with more common postoperative adverse events (32.2%; P < .0001), but a reduced need for secondary surgery (21.7%; P < .0001) and significantly longer surgery-free survival (11.1 ± 0.6 vs 5.4 ± 0.6 y; P < .001).

CONCLUSIONS:

In this retrospective study, we found that although EBD is initially successful with minimal adverse events, there is a high frequency of salvage surgery. Initial ICR is associated with a higher morbidity but a longer surgery-free interval. The risks and benefits should be balanced in selecting treatments for individual patients.

 

 
Question posée
 
Sténose iléo-colique de maladie de Crohn : dilatation endoscopique ou chirurgie d’emblée ?
 
Question posée
 
Cette étude rétrospective monocentrique portant sur 258 patients confirme l’efficacité de la dilatation initiale au prix d’un taux de perforations de 4,7%. Cependant, les patients ayant une sténose longue, une atteinte iléocolique et des intervalles courts entre les dilatations ont un taux élevé de recours secondaire à la chirurgie.
 
Commentaires

Même s’ils sont intéressants, les messages de cette étude sont limités par son caractère rétrospectif et surtout l’évolution considérable des biothérapies au cours de la période évaluée (2000-2016). De nouvelles études sont donc nécessaires avec l’arsenal thérapeutique médicamenteux et endoscopique actuel… 

 
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