NAVIGATING NARROW PATHS, EFFICACY & SAFETY OF ENDOSCOPIC STRICTUROTOMY IN INFLAMMATORY BOWEL DISEASE PATIENTS: A SYSTEMIC REVIEW & META-ANALYSIS

Background & Aims: Endoscopy stricturotomy has gathered attention in the treatment of strictures in patients with inflammatory bowel disease (IBD) and seems to be a promising novel approach. However, the clinical outcomes of endoscopic strictuorotomy have not been well-established due to small-sized studies. We performed a pooled analysis of the efficacy and safety of endoscopic stricturotomy in patients with IBD.

Methods: We searched multiple electronic databases including Medline, Web of Science, CochranePubmed, and Embase and conference proceedings from inception through October 2023 articles reporting outcomes following endoscopic stricturotomy for benign lower gastrointestinal stricturing disease. Two reviewers independently conducted screening, full-text review, and data extraction according to PRISMA guidelines. The clinical outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I2 statistics.

Results: We analyzed 18 studies including 4 prospective and 14 retrospective studies involving 637 patients (363 males with a mean age of 45 years) and a mean duration follow-up of 574 days. 53% of these patients had Crohn’s disease with 85.6% having anastomotic strictures located mostly in the ileocolonic region (26.58%). The median length of the strictures was 1.80 cm. The pooled technical success rate of endoscopic stricturotomy was 95.7 %( CI 92.7 - 97.5%; I2 =0%) and the pooled therapeutic success rate was 67.4% (CI 49.9 - 81.1%; I2 = 72.7%). The pooled major complications per procedure were 5.5% (4.2-7.2%; I2 =0%). The risk of bleeding associated per procedure was 4.8% (3.6-6.5%; I2 =0%, ) whereas the risk of perforation associated per procedure was 1.9% (1.1-3.3%; I2 =0%). There were no reported deaths with endoscopic stricturotomy.
We found that the pooled rate of patients who required repeat stricturotomy was 39.9% (11.6 -75.8%; I2 =91.8%) whereas the pooled rate of patients who required repeat surgery was 16.7% (7.5 -33.1%; I2 =87%).

Conclusions: On meta-analysis, endoscopic stricturotomy demonstrated an excellent pooled technical success rate of 95.7%. However, the pooled clinical success was modest at 67.4%. Pooled adverse events suggest that the procedure is safe with a low risk of perforation at 1.9%. Overall, the results of this analysis seem in favour of endoscopic stricturotomy in patients with IBD. However, in light of modest clinical success and 39.9% of patients requiring repeat stricturotomies, future studies are warranted to ascertain the right patient cohort that would benefit the most.