Physics

Internal medicine

Stent

Disease

Incidence (geometry)

Gastroenterology

Meta-analysis

Optics

Balloon

Surgery

Crohn's disease

Endoscopic stenting

Balloon dilation

Pooled analysis

Confidence interval

Medicine

The American Journal of Gastroenterology

Introduction: Crohn’s disease [CD] is a chronic disabling condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD but data on its safety and efficacy is limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD related strictures. Methods: A systematic and detailed search was run in May 2021 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD related strictures. Meta-analysis was performed using random-effects model and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CI). Results: Eight studies with 193 patients were included in the final analysis. Self-expanding metal stents (SEMS) including Hanarostent, Wallstent UC and Wallflex UC, were used in 6 studies whereas biodegradable stents (SX-ELLA BD) were used in 2 studies. Pooled rate of clinical success and technical success was 59.6% (95% CI 47.4-70.7; I2 38%) and 93.7% (95% CI 86.1-97.3; I2 0%), respectively. Pooled incidence of post procedure abdominal pain and stent migration was 12.2% (95% CI 4.8-27.3; I2 46%) and 12.1% (95% CI 6.9-20.2; I2 0%), respectively. Overall pooled incidence of symptom recurrence in patients requiring re-stenting, EBD and/or surgery was 26.7% (95% CI 14.5-43.9; I2 43%). Mean follow up period ranged from 3 months to 69 months. Conclusion: Endoscopic stenting in CD related strictures is a safe technique but with a limited clinical success. Post procedure abdominal pain and stent migration are some of the common adverse events reported. Recurrence of symptoms, requiring additional therapy, can be seen in up to a quarter of patients.Figure 1.: Forest plot of all 25 studies looking at rectal NSAIDs for the prevention of PEP.Table 1.: Study Details.

S1019 Endoscopic Stenting in Crohn's Disease Related Strictures: A Systematic Review and Meta-Analysis of Outcomes