ENDOSCOPIC BALLOON DILATATION VERSUS ENDOSCOPIC NEEDLE KNIFE STRICTUROTOMY VS ENDOSCOPIC STENTING FOR MANAGEMENT OF STRICTURES SECONDARY TO INFLAMMATORY BOWEL DISEASE: A META-ANALYSIS AND SYSTEMIC REVIEW

Background and Aims: Strictures commonly complicate inflammatory bowel disease (IBD), either as an intrinsic aspect of the disease or following surgery. Management options for these strictures include surgery and various endoscopic therapies such as balloon dilation, stenting, and stricturotomy. While these endoscopic techniques differ in success rates, re-intervention frequencies, and adverse effects, comparative evidence regarding their efficacy and safety is scarce. This study aims to compare the effectiveness and safety of balloon dilation, endoscopic stenting, and needle knife stricturotomy in treating IBD-related strictures.
Methods: We conducted a comprehensive literature search across electronic databases including PubMed, Embase, Scopus, Cochrane, and CINAHL, spanning the period from 2000 to October 2023. Our meta-analysis focused on primary outcomes (Clinical Success) defined as the resolution of symptoms post-technically successful intervention, and secondary outcomes (adverse event rates), using R software version 4.3.1.
Results: Data from 904 patients across 21 studies (9 balloon dilation, 7 stenting, 4 stricturotomy) were pooled. Analysis using multiple linear regression and odds ratio calculations revealed:
Highest technical success with stricturotomy (100%; coefficient 99.77), followed by stenting (98.7%; coefficient 96.85), and balloon dilation (92.1%; p<0.001).
Stenting demonstrated the greatest clinical success (coefficient 78.48), surpassing stricturotomy (72.65; p<0.005).
Balloon dilation showed the lowest incidence of adverse events. Detailed results, including statistical analyses, are presented in Table 1. No publication bias was detected in funnel plot inspections.
Conclusion: Stricturotomy exhibits the highest technical success rate, as indicated by an odds ratio of 4.01 (95% CI 2.6-5.41, p-value <0.001). In contrast, stenting leads in terms of clinical success (odds ratio 0.84, 95% CI 0.52-1.17). Notably, balloon dilation emerges as the safest option, with the lowest rate of adverse effects. Our findings suggest that while stricturotomy is technically the most successful, stenting achieves better clinical outcomes, and balloon dilation is associated with fewer complications. Further randomized trials are needed further to shed light on the efficacy of these therapies.