Korean J Gastroenterol.  2022 Oct;80(4):177-185. 10.4166/kjg.2022.077.

Efficacy and Safety of Endoscopic Stenting for Crohn's Disease Related Strictures: A Systematic Review and Meta-analysis

• Giri S
• Gopan A
• Sundaram S
• Kale A

• KMID: 2534466
• DOI: http://doi.org/10.4166/kjg.2022.077

Abstract

Background/Aims
Endoscopic stenting is an evolving treatment for symptomatic Crohn's strictures. Several case series and small studies have reported its efficacy. Future studies can be designed based on a systematic review of the evaluation of efficacy. Hence, this meta-analysis was conducted to assess the critical role of stents in the management of intestinal strictures associated with Crohn's disease (CD).
Methods
A literature search of various databases from 2000 to February 2022 was conducted for studies evaluating the outcome of stents in patients with CD-related stricture. The outcomes assessed included technical and clinical success, adverse events, symptom recurrence, and the need for a surgical resection. Pooled event rates across studies were expressed with summative statistics.
Results
Ten studies with 170 patients were included in the present analysis. The pooled event rates for technical success, clinical success, stent migration, and post-procedural pain were 98.2% (95% CI, 95.8-100), 71.3% (95% CI, 57.4-85.1), 32% (95% CI, 0.0-65.3) and 20.2% (95% CI, 4.1-36.2), respectively. The cumulative recurrence rate and need for surgery were 40.1% (95% CI, 20.3-59.9) and 8.6% (95% CI, 1.7-15.5), respectively. Subgroup analysis showed that partially-covered (PC) self-expanding metallic stent (SEMS) was significantly better than fully-covered SEMS with a lower stent migration rate and symptom recurrence rate.
Conclusions
Overall efficacy of stents in the management of CD-related stricture remains moderate with a low complication rate. Among the stents, PC-SEMS may be associated with a more favorable outcome. Future studies will be needed to determine the long-term benefits of endoscopic stenting.

Keyword

Crohn disease; Strictures; Self expandable metallic stents; Meta-analysis

Figure

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  Fig. 1 PRISMA 2020 flow diagram for study selection for systematic review and meta-analysis.

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  Fig. 2 Forest plot for the technical success of endoscopic stenting in Crohn's disease-related stricture with subgroup analysis based on stent type.

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  Fig. 3 Forest plot for clinical success of endoscopic stenting in Crohn's disease-related stricture with subgroup analysis based on stent type.

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  Fig. 4 Forest plot for stent migration with subgroup analysis based on the stent type.

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  Fig. 5 Forest plot for recurrence rate with subgroup analysis based on stent type.

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  Fig. 6 Forest plot for the need for surgery due to failure to improve or recurrence after stenting.

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