Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease
Abstract
:1. Introduction
2. Search Strategy
3. Endoscopic Therapy for Strictures in IBD
3.1. Endoscopic Balloon Dilation (EBD)
3.1.1. Outcomes of EBD
3.1.2. Predictors of EBD Success and Surgery-Free Disease Course
Number of Patients | Location, Type of Strictures | Technical Success | Clinical Success | Recurrence Rates | Complications | Repeat Dilation | Surgery on Follow Up | Median Follow Up Period (Months) | |
---|---|---|---|---|---|---|---|---|---|
Ferlitsch et al., 2006 [4] | 46 | Ileo-colonic Anastomotic | 95% | 89.7% | 62% | 4% | 31% | 33% | 21 |
Nomura et al., 2006 [5] | 16 | Ileo-colonic, ileo-ileal anastomosis | 93% | 93% | 46.6% | 25% | 25% | 44% | 38.5 |
Ajlouni et al., 2007 [6] | 37 | De novo and anastomotic Ileo-colonic | 90% | 90% | 32.2% | 3% | 21.6% | 5.4% | 20 |
Pohl, 2007 [7] | 10 | Small bowel | 80% | 60% | - | 0% | 50% | 40% | 10 |
Ohmiya, 2009 [8] | 16 | Small bowel | 96% | 100% | n.a | 0% | 12.5% | 18.8% | 16% |
Despott, 2009 [9] | 11 | Small bowel | 81.8% | 72.7 | n.a | 9.1% | 22.2% | 9.1% | 20.5 |
Steinecker et al., 2009 [10] | 25 | Lower GI tract (primary or anastomotic) | 97% | 96% | 46% | 3% | 29.2% | 16.7% | 81 |
Hirai, 2010 [11] | 25 | Small bowel | 72% | 72% | 17% | 8% | 22.2% | 28% | 11.4% |
Mueller et al., 2010 [12] | 55 | Duodenum, terminal ileum, colon, ileo-colonic anastomosis | 95% | 76% | 9.2% | 1.8% | 47% | 24% | 44 |
Thienpont et al., 2010 [13] | 138 | Ileal, Ileocolonic | 97% | - | 55.8% | 5.1% per patient analysis | 46% | 24% | 69.6 |
Gustavsson et al., 2012 [14] | 178 | Anastomotic, upper GI, small bowel, ileo-colonic | 89% | 77% | 66.4% | 5.3% | 66% | 36% | 144 |
De Angelis et al., 2013 [15] | 26 | Anastomotic, upper GI, small bowel, ileo-colonic | 100% | 81.5% | 54.2% | 0% | 54% | 8% | 40.7 |
Endo et al., 2013 [16] | 30 | De novo and anastomotic | 93.6% | 93.6% | 60.5% | 10.6% | 60.5% | 37% | 26 |
Atreja et al., 2014 [17] | 128 | De novo and anastomotic Ileo-colonic | 83% | - | 73.4% | 3.1% | 58.6% | 32.8% | 21.6 |
Bhalme et al., 2014 [18] | 79 | Anastomotic, upper GI, small bowel, ileo-colonic | 95% | 43% | 66% | 4% | 66% | 23% | 26.8% |
Chen et al., 2014 [19] | 60 | Anastomosis, ileo-colonic | 94% | - | 16.7% | 0% | 31.7% | 33.3% | 50 |
Navaneethan et al., 2014 [20] | 8 | Small bowel | 75% | - | - | n.a | 66.6% | n.a | n.a |
Gill et al., 2014 [21] | 10 | Small bowel | 100% | 80% | - | 20% | 40% | 30% | 16 |
Hirai, 2014 [22] | 65 | Small bowel | 80% | 80% | - | 4.6% | 50% | 26.2% | 40.3 |
Lian et al., 2015 [23] | 185 | Ileo-colonic Anastomotic | 91% | - | - | 1.1% | - | 35.7% | 46.8 |
Ding et al., 2015 [24] | 54 | Anastomotic | 98% | 98% | 68.5% | 1.8% | 68.5% | 18.5% | 72 |
Guo et al., 2016 [25] | 24 | Upper GI | 92.5% | 95.8% | 79.2% | 8.4% | 79.2% | 24% | 23 |
Sunada et al., 2016 [26] | 85 | Small bowel | - | - | - | 5.9% | 75.3% | 24.7% | 41.9 |
Bettenworth et al., 2017 [27] | 1463 | Ileal (98.6%) and anastomotic (62%) | 89.1% | 80.8% | 47.5% | 2.8% | 73.5% | 42.9% | 24 |
Lian et al., 2017 [28] | 176 | Ileo-colonic Anastomotic | 90.3% | - | - | 8.8%% | - | 51.7% | 21.6 |
Reutmann et al., 2017 [29] | 135 | De novo and anastomotic Ileo-colonic | 74% | - | - | 0.7% | - | 28.1% | 41.7 |
Singh et al., 2017 [30] | 35 | Stomach, Duodenum | 93% | 87% | 75% | 4% | 93% | 34% | 15.1 |
Nishida et al., 2017 [31] | 37 | Small bowel | - | - | - | 8.1% | - | 48.6% | 27.1 |
Lee et al., 2018 [32] | 30 | Stomach (n = 1), small bowel (n = 5), colon (n= 36) both ulcerative colitis and Crohn’s disease | 86.7% | 93.3% | 26.7% | 6.7% | 26.7% | 3.3% | 134.8 |
Shivashankar et al., 2018 [33] | 273 | Entire GI tract, Pouch, anastomosis | 91.3% | 91.3% | 41.8% | 2.1% | 41.8% | 30% | 31.2 |
Winder et al., 2019 [34] | 64 | Primary, Anastomotic, Ileo-colonic. | 89.9% | 84.7% | - | 5% | - | 32.8% | 39.6 |
Chang et al., 2020 [35] | 26 | Ileo-colonic, upper GI | 96.2% | 83.3% | 17.1% | 2.4% | - | 26.9% | 75 |
Andujar et al., 2020 [36] | 187 | Anastomotic, pouch, ileo-colonic | 79.5% | 55.3% | - | 1.3% | 49.7% | 20.9% | 40 |
Sivasailam et al., 2021 [37] | 99 | Ileo-colonic, anastomotic | 75% | - | 52% | 3.3% | 52% | 33% | 62 |
Wewer et al., 2022 [38] | 90 | Small bowel, de novo and anastomotic | - | - | 45.5% | - | 14% | 27% | 60 |
Watanabe et al., 2022 [39] | 75 | Small bowel, large bowel, anastomosis | - | 78.5% | 68% | 1.1% | - | 40.5% | 82 |
Pal et al., 2022 [40] | 44 | Upper GI, Small bowel, Large bowel, pouch, anastomosis | 81.8% | 95.4% | 27.3% | 9.1% | 22.7% | 2.3% | 5 |
Lee et al., 2022 [41] | 114 | Upper GI, Small bowel, Large bowel | 96.4% | 54.3% | - | 0.8% | 16.7% | 18.4% | >6 |
Ladron et al., 2022 [42] | 32 | Anastomotic | 63.5% | 62.5% | - | 3.2% | 47% | 37.5% | 72 |
Hibiya et al., 2022 [43] | 98 | Small bowel | 98.3% | - | - | 2% | 75% | 24.5% | 12 |
4. Endoscopic Stricturotomy
4.1. Method of ES
4.2. Indications of ES Comparison with Other Techniques
Study, Year of Publication | Etiology | Technical Success | Clinical Success | Recurrence Rates | Complications | Repeat Interventions | Surgery on Follow Up | Median Follow Up (Months) |
---|---|---|---|---|---|---|---|---|
Lan et al., 2017 [48] | 85 Ileal pouch (n = 50), Crohn’s disease (n = 35) (14 combined EBD) | 100% | 54.7% (29/53 with immediate clinical follow up) | 60.6% | 3.7% (bleeding 3.3%, perforation 0.4%) | 60.6% | 15.3% | 11 |
Lan et al., 2018 [49] | Anastomotic strictures | 100% | 72.7% (vs. EBD 45.4%) | 61.9% | 14.3% (bleeding which required transfusion) | 61.9% | 9.5% | 9 |
Zhang et al., 2020 [50] | 49 IBD related | 100% | IBD (67.6%) | 34.7% | 4.7% (bleeding) | 49% additional ES, 20.4% additional EBD | 12.2% | 11 |
Navaneethan U et al., 2020 [51] | 2 Crohn’s disease | 100% | 100% | - | 0% | - | - | - |
Mohy-ud-din et al., 2020 [52] | 11 (IBD, including pouch) | 92% | 92% | - | 9% (self limiting bleeding) | 8% repeat ES | 9% | 5 |
Moroi et al., 2020 [53] | CD-4 Anastomotic and 1 primary stricture | 100% | 100% | - | 20% (delayed bleeding) | - | - | - |
Lan et al., 2020 [54] | Crohn’s de novo distal ileal strictures (n = 13), (versus ileo-cecal resection, n = 32) | 100% | ES (50.0%) (90% with ileo-cecal resection) | 38.5% | 6.9% | 15.4% (surgery) | 15.4% | 21 |
Lan et al., 2021 [55] | 40 Pouch strictures (vs. EBD-160) | 100% | 42.3% (vs. 13.2% EBD) | 44.4% (vs. 41.3% EBD) | 4.7% (bleeding) (vs. 0.8% EBD) | 22.5% | 22.5% (vs. 20.6%) | 7 |
5. Endoscopic Stenting
5.1. Indications and Types
Name of Stent | Diameter (mm) | Length (cm) | Stent Type | Specifics |
---|---|---|---|---|
Niti S enteral colonic covered stent | 18–22 | 6–15 | Fully covered enteral stent | High migration rates |
HANARO stent | 20 (26 at ends) | 2.4, 5.4, 7.4 (6, 9, 11) | Partially covered self-expanding metal stent | Lower migration rates |
Axios stent | 10–20 (21–29 for flanges) | 1 (saddle length) | Lumen apposing metal stent | Short delivery catheter (not for proximal stenosis) |
SX-ELLA-Biodegradable stents | 18, 20, 23, 25 (23, 25, 28, 31) | 6, 8, 10 | Biodegradable stent | Not through the scope (TTS), made of polydioxanone, degraded in 10–12 weeks |
5.2. Technical Tips for Endoscopic Stenting in IBD
5.3. Results of Endoscopic Stenting
Author/Year | No. of Patients | Length | Stent Type | Technical Success | Clinical Success | Recurrence | Adverse Events/Migration | Repeat Intervention | Duration of Stenting (Weeks) | Surgery | Follow Up (Months) |
---|---|---|---|---|---|---|---|---|---|---|---|
Whole et al., 1998 [60] | 1 Colon, CD | - | Tracheo-bronchial Wallstents | 100% | 100% | - | - | 100% | 3 | Used as bridge to surgery | 0.75 |
Matsuhashi et al., 2000 [61] | 2 Colon, IC Anastomosis, Post EBD | - | FCSEMS (specially modified) | 100% | 100% | 0% | 100% (migration) | 0% | 4 and 22 | 0% | 54 |
Suzuki et al., 2004 [62] | 2 Colon | - | USCEMS | YES | yes | Yes | Fistula in 1 | Surgery and repeat stenting | 3 and 104 | 1/2 | 3 and 26 |
Bickston et al., 2005 [63] | 1 ileo-cecal Post EBD | - | 2 UCSEMS | yes | yes | - | - | - | 8 | Used s bridge to surgery | 2 |
Wada et al., 2005 [64] | 1 Colon | - | UCSEMS | Yes | yes | Restenosis | Perforation, fistula | Yes- surgery | 139 | Yes | 8 |
Dafnis et al., 2007 [65] | 1 colon | 5 cm | 4UCSEMS | yes | yes | Yes | - | 4 times | 14 | No | 1 |
Martines et al., 2008 [66] | 1 IC anastomosis Post EBD | 6 cm | FCSEMS | Yes | yes | - | - | - | 1 | Used as bridge to surgery | 0.25 |
Small et al., 2008 [67] | 1 rectum | - | 2 PCSEMS | yes | yes | - | - | - | 1 | Used as bridge to surgery | - |
Keranen et al., 2010 [68] | 2 Anastomosis | - | FCSEMS UCSEMS | yes | yes | - | Perforation-1 | Surgery 1 | 6 and 221 | 1/2 | - |
Rejchrt et al., 2011 [69] | 11 CD Post EBD 07 | 1.5–5 | Polydioxanone biodegradable stent | 90% | 63% | 36.3% | 27% early stent migration | - | 16 | - | 16 |
Attar et al., 2012 [70] | 11 CD Post EBD-9 | 1–4 cm | FCSEMS | 90% | 36% | 63.6% (1 year), total 90% | 10% proximal migration, 70% migration | 18.2% | <4 | 18.2% | 26 |
Branche et al., 2012 [71] | 7 CD Ileo-colonic (IC) anastomosis Post EBD | <5 cm | PCSEMS | 100% | 71.4% | 28.5 | 42.8% pain | 14% (EBD) | 1 | 0% | 10 |
Levin et al., 2012 [72] | 5 IC anastomosis Post EBD-2 | <5 cms | UCSEMS | 100% | 80% | 20% | 0% | 20% | 3 (1 patient at 9 years) | 20% | 28 |
Loras et al., 2012 [73] | 17 CD Post EBD 14 | 2–6 cm | PCSEMS/FCSEM | 94.1% | 64.7% | 31% | 5.9% spontaneous migration 52% migration | - | Mean-4 | 43.7% | 12 |
Karstensen et al., 2016 [74] | 6 CD Post EBD | 2–10 | Polydioxanone monofilament, biodegradable stent | 83% | 20% | 80% | 17% stent migration | - | - | - | 4–42 |
Axelrad et al., 2018 [75] | 1 Rectal-colon anastomosis Post EBD | 1 cm | LAMS | Yes | Yes | 0% | No | - | 8 | - | 3 |
Oztas et al., 2018 [76] | 1 IC anastomosis | 3 cm | UCSEMS | Yes | Yes | Yes | 0% | Yes, (PC-SEMS within FC SEMS) | 24 (UC SEMS), 52 (PC SEMS) | - | 12 months |
Ouali et al., 2019 [77] | 1 Pouch inlet stricture Post EBD/ES | 10 cm | FC-SEMS | yes | yes | Yes | spontaneous migration | EBD, ES | 1 | 0% | - |
Fung et al., 2020 [78] | 1 Descending colon | - | UCSEMS | yes | yes | No | spontaneous migration | No | < 1 | No | 10 |
Das et al., 2020 [79] | 21 CD | <6 cm | PCSEMS | 95.8% | 54.2% | 12.5% | 21.7% (2 pain, 3 migration) | 9.5% restenting | 1 | - | 3–50 |
Lamazza et al., 2021 [80] | 4 rectum Post EBD | - | FCSEMS | 100% | 100% | 75% | 25% migration | 75% (2 EBD, 1 surgery) | 2–12 | 25% | 12 |
Attar et al., 2021 [81] | 46 CD Post EBD-36 | Mean 3.9 cm (all <5 cm) | PCSEMS (Hanaro stent) | 100% | 58.7% | 6.5% | 15.2% (4 pain, 3 proximal migration) | 34.8% | 1 | 17.3% | 26 |
Heden strom et al., 2021 [82] | 7 CD | - | PC SEMS | 100% | 86% | - | 71.4% (4 pain, 1 bleeding) | 14.2% | 1 | 14.2% | 69 |
Andújar et al., 2022 [83] | 39 CD | Mean 4 cm (all <9 cm) | FCSEMS | 92.3% | 51% | - | 7.7% (2 proximal migration, 1 perforation) | 49% | <1 | - | 12 |
6. Endoscopic Management of Fistula and Abscesses
6.1. Endoscopic Drainage
6.2. Endoscopic Fistulotomy
6.3. Injection of Filling Materials
6.3.1. Glue
6.3.2. Fistula Plug
6.3.3. Stem Cells
6.3.4. Sclerosing Agents
6.4. Endoscopic Closure
6.4.1. Endoscopic Clipping
6.4.2. Endoscopic Suturing
6.4.3. Endoscopic Stenting
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Pal, P.; Kanaganti, S.; Banerjee, R.; Ramchandani, M.; Nabi, Z.; Reddy, D.N.; Tandan, M. Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease. Gastroenterol. Insights 2023, 14, 45-63. https://doi.org/10.3390/gastroent14010006
Pal P, Kanaganti S, Banerjee R, Ramchandani M, Nabi Z, Reddy DN, Tandan M. Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease. Gastroenterology Insights. 2023; 14(1):45-63. https://doi.org/10.3390/gastroent14010006
Chicago/Turabian StylePal, Partha, Swathi Kanaganti, Rupa Banerjee, Mohan Ramchandani, Zaheer Nabi, Duvvuru Nageshwar Reddy, and Manu Tandan. 2023. "Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease" Gastroenterology Insights 14, no. 1: 45-63. https://doi.org/10.3390/gastroent14010006