双腔气囊小肠镜对小肠炎症性疾病相关狭窄的治疗

目的：探讨双腔气囊小肠镜的内镜下球囊扩张(endoscopic balloon dilation，EBD)和狭窄切开(endoscopicstricturotomy with needle knife，NKSt)对于小肠炎症性疾病相关狭窄治疗的安全性及有效性。方法：收集2015年7月至2018年9月在中南大学湘雅三医院行双腔气囊小肠镜狭窄治疗的患者14例，病变部位16处，内镜下干预16次(EBD 11次和NKSt 5次)。术后定期随访，观察患者的临床症状缓解和复发情况，以及是否能替代外科手术。结果：14例患者均成功行内镜治疗，操作成功率100%，未发生穿孔、大出血等严重并发症。EBD和NKSt患者分别在随访5.9~35.3(中位数26.1)个月及1.6~17.8(中位数8.3)个月内梗阻症状得到有效缓解，其中2例患者随访期间出现再次梗阻，予以保守对症处理后缓解，未行外科手术干预。结论：小肠镜下治疗(EBD和NKSt)对小肠炎症性疾病狭窄安全有效，可以推迟外科手术时间。

Treatment of inflammatory bowel disease-relevant strictures by double balloon enteroscopy

Objective: To evaluate the safety and efficacy of endoscopic balloon dilation (EBD) andendoscopic stricturotomy with needle knife (NKSt) in patients with infl ammatory bowel diseases(IBD)-relevant strictures.Methods: From July 2015 to September 2018, 14 patients undergoing double balloon-enteroscopyat the Th ird Xiangya Hospital of Central South University were enrolled. Th ere was a total of 16lesions. Endoscopic intervention was performed for 16 times. EBD was done for 11 times, and5 stricturotomies were carried out. Regular follow-up and examinations were done to observewhether there was remission or recurrence of clinical symptoms and replacement surgery.Results: All 14 patients were successfully treated by endoscopy, and the success rate was 100%.Postoperative clinical symptoms were alleviated, and serious complications, such as perforation orhemorrhaging, did not occur. Obstructive symptoms were effectively alleviated at a median followupof 26.1 months (5.9–35.3 months) and 8.3 months (1.6–17.8 months) for patients with balloondilatation and stricturotomy, respectively. Two patients presented with symptoms of obstruction.These were given conservative symptomatic treatment without surgical intervention.Conclusion: Enteroscopic treatments (EBD and NKSt) are safe and effective for intestinalstrictures, and can prolong the time before surgical intervention is needed.