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KMID : 0614620220800040177
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Korean Journal of Gastroenterology
2022 Volume.80 No. 4 p.177 ~ p.185
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Efficacy and Safety of Endoscopic Stenting for Crohn's Disease Related Strictures: A Systematic Review and Meta-analysis
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Gir Suprabhat
Gopan Amrit
Sundaram Sridhar
Kale Aditya
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Abstract
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Background/Aims: Endoscopic stenting is an evolving treatment for symptomatic Crohn's strictures. Several case series and small studies have reported its efficacy. Future studies can be designed based on a systematic review of the evaluation of efficacy. Hence, this meta-analysis was conducted to assess the critical role of stents in the management of intestinal strictures associated with Crohn's disease (CD).
Methods: A literature search of various databases from 2000 to February 2022 was conducted for studies evaluating the outcome of stents in patients with CD-related stricture. The outcomes assessed included technical and clinical success, adverse events, symptom recurrence, and the need for a surgical resection. Pooled event rates across studies were expressed with summative statistics.
Results: Ten studies with 170 patients were included in the present analysis. The pooled event rates for technical success, clinical success, stent migration, and post-procedural pain were 98.2% (95% CI, 95.8-100), 71.3% (95% CI, 57.4-85.1), 32% (95% CI, 0.0-65.3) and 20.2% (95% CI, 4.1-36.2), respectively. The cumulative recurrence rate and need for surgery were 40.1% (95% CI, 20.3-59.9) and 8.6% (95% CI, 1.7-15.5), respectively. Subgroup analysis showed that partially-covered (PC) self-expanding metallic stent (SEMS) was significantly better than fully-covered SEMS with a lower stent migration rate and symptom recurrence rate.
Conclusions: Overall efficacy of stents in the management of CD-related stricture remains moderate with a low complication rate.
Among the stents, PC-SEMS may be associated with a more favorable outcome. Future studies will be needed to determine the long-term benefits of endoscopic stenting.
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KEYWORD
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Crohn diseasel, Strictures, Self expandable metallic stents, Meta-analysis
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