Mo1756 EFFICACY OF ENDOSCOPIC STRICTUROTOMY IN THE MANAGEMENT OF BENIGN LOWER GASTROINTESTINAL STRICTURING DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Gastrointestinal stricturing disease is a frequent complication of inflammatory bowel disease (IBD) and colorectal resection. Endoscopic stricturotomy (ES) is a novel technique that allows for controlled mucosal incision via electrocautery and has been reported in the literature as an alternative treatment for intestinal strictures. The aim of this meta-analysis was to evaluate the efficacy and safety of ES in the treatment of benign lower gastrointestinal stricturing disease. We performed a comprehensive search of MEDLINE, EMBASE, Web of Science, and The Cochrane Library databases for peer-reviewed journal articles reporting outcomes following ES for benign lower gastrointestinal stricturing disease. Two reviewers independently conducted screening, full text review, and data extraction according to PRISMA guidelines. Primary outcomes included technical success, endoscopic recurrence, surgical intervention following ES, and major adverse events. A total of 10 studies involving 332 patients were included in the analysis. The mean sample size was 33 subjects (range, 5–85 subjects), and the mean age was 55 years (range, 41–66 years). Forty-two percent of patients in the total cohort had IBD. The majority of strictures treated were anastomotic (83.7%) and located at the colorectal anastomosis (57.9%) (Table 1). The fixed effects model estimate of technical success was 98.5% (k=10 studies, 95% CI=97.3%–99.7%) (Figure 1A). The mean duration of follow-up was 29.4 months (range, 10.1–70.5 months). The random effects model estimate of endoscopic recurrence following ES was 22.7% (k=10 studies, 95% CI=8.3%–37.0%) (Figure 1B). The random effects model estimate of surgical intervention rate following ES was 4.1% (k=10 studies, 95% CI=2.1%–6.1%) (Figure 1C). Meta-regression analysis indicated that monotherapy with ES, compared to combination therapy (ES with balloon dilatation), had similar risks of endoscopic recurrence (RR=1.44, P=0.69). Underlying IBD was associated with an increased risk of endoscopic recurrence (RR=6.47, P=0.03), and a higher mean stricture length showed a trend towards increasing the risk of endoscopic recurrence (RR=1.12, P=0.05). Older mean age at time of ES was associated with a lower risk of endoscopic recurrence (RR=0.91, P=0.001). ES resulted in major adverse events in 5.4% of patients, including 16 patients with major bleeding and 2 patients with perforation. There were no reported deaths with ES. ES is a technically effective and safe procedure for treating benign lower gastrointestinal strictures, with a low rate of major adverse events. Monotherapy with ES, compared to combination therapy, has similar risks of endoscopic recurrence. The technical efficacy of ES is comparable in non-IBD and IBD groups, though underlying IBD is associated with increased risk of recurrent stricturing disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)