| Objective To investigate the differential diagnosis value of balloon-assisted enteroscopy（BAE）in the stenostic small bowel CD and other small bowel benign stenosis.To evaluate the differential diagnosis value of BAE in CD small bowel stenosis and other non-infectious small bowel benign stenosis.To evaluate the feasibility,safety and efficacy of Endoscopic stricturotomy（EST）by balloon-assisted enteroscopy（BAE）for small bowel benign stenosis.Methods1.From October 2014 to June 2021,clinical data of 67 patients with small bowel benign stenosis in our center were collected and analyzed.Outcomes after BAE of included patients were also collected by follow-up.Four patients lost to follow-up and two patients corrected for lymphoma after follow-up were excluded,61 patients with small bowel benign stenosis were finally included in this study（may 2015 to June 2021）.Consistency between clinical diagnosis based on BAE and final diagnosis based on follow-up was evaluated.Evaluate the value of BAE in the differential diagnosis of small bowel benign stenosis.Patients with non-infectious small bowel stenosis were under contrastive analysis.Appearances in BAE were compared between Crohn’s disease（CD）group and other non-infectious small bowel benign stenosis group.The BAE appearances of CD patients with a course of less than 1 year and more than 1 year were compared.The last follow-up time was October 30,2021.2.We retrospectively analyzed the clinical characteristics of 21 patients suffered with small bowel benign stenosis and accepted EST by BAE from December 2015 to August2021.Evaluate the feasibility and complications of EST by BAE,and improvement of clinical symptoms after EST.The outcomes were evaluated by follow-up.The technical success rate,complication rate and curative effect,symptom-free survival rate were calculated.In the same period,20 patients underwent surgery for small bowel benign stenosis treatment.Comparations were done for safety and efficiency between patients accepted EST by BAE and patients accepted surgery for small bowel benign stenosis in the same period.To analyze the clinical data and endoscopic treatment of patients who did not convert to surgery and patients with complete remission of symptoms after EST treatment.The last follow-up time was February 10,2022.Results1.Differential diagnosis value and endoscopic characteristics with BAE in small bowel benign stenosis（1）The main cause of small bowel benign stenosis was CD（62.3%,38/61）,and other causes included cryptogenic multifocal ulcerous stenosing enteritis（CMUSE）（11.5%,7/61）,small bowel tuberculosis（6.6%,4/61）.（2）The overall consistent rate of BAE based clinical diagnosis and final diagnosis was80.3%（49/61）for patients with small bowel benign stenosis.The sensitivity and specificity of BAE in the differential diagnosis of CD small bowel stenossis were 97.4%and 82.6%.（3）Compared to other non-infectious diseases with small bowel benign stenosis,CD patients showed more non-transverse ulcers at the stenosis（53.1% vs 16.7%,P=0.016）,more non-stenostic ulcers in ileum（38.9% vs 0.0%,P=0.010）,and less transverse ulcers at the stenosis（46.9% vs 83.3%,P=0.016）,P<0.05,the differences were statistically significant.No significant differences were detected between CD and non-CD patients in aspects of location,degree,morphology（diaphragmatic stenosis/short stenosis/long stenosis）,the presence of multiple stenosis and fibrotic stenosis.（4）The CD patients whose courses were more than 2 years were more likely to have multiform stenosis（36.4% vs 0.0%,P=0.012）,P<0.05,the difference was statistically significant.2.The value of EST in the treatment of benign small intestinal stenosis with BAE（1）A total of 21 patients with 43 small bowel benign stenosis were treated with EST by26 BAE procedures.The mean age was 45.2 ± 17.4 years,and sex ratio was1.3:1（male/female）.The main cause of stenosis was Crohn’s disease（CD）（15/21,71.4%）.The immediate technical success rate of EST was 95.3%（41/43）,the complication rate was 26.9%（7/26）and two（9.5%）patients were undergone surgery as the result of EST-related perforation.By the end of follow-up（median follow-up time12（6-46）months）,76.2%（5/21）of the patients were surgery-free after EST treatment.In the same period,20 patients underwent surgery for small bowel benign stenosis treatment.Compared with the surgery group,the immediate technical success rate（95.3% vs 100%,P=0.512）and complication rate（26.9% vs 10.0%,P=0.262）in the EST group（P>0.05）,the differences were no statistically significant.（2）The symptom remission rate of EST group compared with the surgery group（89.5%vs 100%,P=0.231）at 3-month,the difference was no statistically significant.At6-month and 1-year,the symptom remission rates of EST group were lower than the surgery group（78.9% vs 100%,72.7% vs 100%,P=0.047 P=0.037）,the differences were statistically significant.At 3-month,6-month and 1-year,the cumulative symptom-free survival rates were 66.0% vs 90.0%,61.0% vs 85.0%,54.0% vs 80.0%,respectively.Kaplan-Meier analysis showed the symptom-free survival curve between two groups（P=0.051）,the difference was no statistically significant.The median symptom-free survival time of EST was 13.3 months.The 3-month,6-month and 1-year cumulative surgery-free survival rates after EST treatment were 90.0%,81.0% and73.0%,respectively.Kaplan-Meier analysis showed the symptom-free survival curve of CD patients between two groups（P=0.185）,the difference was no statistically significant.（3）Comparison of clinical data between patients with complete and incomplete remission of symptoms after 6 months and 1 year EST treatment.It was found that the average age of patients with complete remission was older than that of patients with incomplete remission（52.2±15.1 vs 30.7±10.8,P=0.004;56.2±13.0 vs 31.0±13.1,P=0.011）,the difference was no statistically significant.Conclusion1.BAE has pretty clinical value in the differential diagnosis of small bowel benign stenosis when combining with endoscopic biopsy,clinical manifestations,Imaging and laboratory examination.But it still needs to be comprehensively analyzed in combination with other examination methods（including surgery）and the results of long-term follow-up after treatment.CD patients with longer course are more likely to have multiform stenosis.Non-stenostic ulcers in ileum and non-transverse ulcers under endoscopy are helpful to distinguish small bowel stenosis of CD from other non-infectious small bowel benign stenosis diseases.2.EST by BAE is technically feasible and safe in the treatment of small bowel benign stenosis.The medium-term and short-term of the symptom-free survival rate is relatively high.It can effectively relieve symptoms of obstruction and help delaying or avoiding surgery.Age may be a factor related to the outcome of EST treatment.However,the sample size is small,and more samples are needed to screen the best indications for small bowel EST treatment. |
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