Stricturing Crohn's disease: what is the role of endoscopic stenting? A systematic review
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Background/Aims: Endoscopic stenting for stricturing Crohn’s disease (CD) is an emerging treatment that achieves more persistentdilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stentingfor the treatment of CD strictures. Methods: A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes weretechnical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partiallycovered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed. Results: Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentageof technical success was 95% (range, 80%–100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range,25%–90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%–90%), the mean complicationrate was 35% (range, 15%–57%), and the major complication rate was 11% (range, 0%–29%). Conclusions: Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CDstrictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an al-ternative or additional treatment to EBD in CD.
Abstract
Background/Aims: Endoscopic stenting for stricturing Crohn’s disease (CD) is an emerging treatment that achieves more persistentdilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stentingfor the treatment of CD strictures. Methods: A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes weretechnical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partiallycovered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed. Results: Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentageof technical success was 95% (range, 80%–100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range,25%–90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%–90%), the mean complicationrate was 35% (range, 15%–57%), and the major complication rate was 11% (range, 0%–29%). Conclusions: Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CDstrictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an al-ternative or additional treatment to EBD in CD.
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