Therapeutic strategies for stricturing Crohn’s disease in childhood: a systematic review

Abstract

Purpose Childhood stricturing Crohn’s disease (CD) has significant morbidity. Interventions including resection, stricturoplasty and endoscopic balloon dilatation (EBD) are often required. Optimal intervention modality and timing, and use of adjuvant medical therapies, remains unclear. We aim to review the therapies used in paediatric stricturing CD. Methods A systematic review in accordance with PRISMA was performed (PROSPERO: CRD42020164464). Demographics, stricture features, interventions and outcomes were extracted. Results Fourteen studies were selected, including 177 patients (183 strictures). Strictures presented at 40.6 months (range 14–108) following CD diagnosis. Medical therapy was used in 142 patients for an average of 20.4 months (2–36), with a complete response in 11 (8%). Interventions were undertaken in 138 patients: 53 (38%) resections, 39 (28%) stricturoplasties, and 17 (12%) EBD. Complications occurred in 11% of resections, versus 15% stricturoplasties, versus 6% EBD (p = 0.223). At a median follow-up of 1.9 years (interquartile range 1.2–2.4) pooled stricture recurrence was 22%. Resection had 9% recurrence, versus 38% stricturoplasty, versus 47% EBD (p < 0.001). Conclusions Resection is associated with a low incidence of recurrence and complications. There remains a paucity of evidence regarding adjuvant medical therapy and the role of EBD. We propose a minimum reported dataset for interventions in paediatric stricturing CD.

Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

“…• Debe realizarse una endoscopia cuando se sospecha pouchitis. • En estenosis únicas, mayores de 4 cm o múltiples, no se recomienda el uso de dilatación con balón por el mayor riesgo de complicaciones y menor tasa de éxito (28) . • Antes de realizar la dilatación endoscópica se recomienda caracterizar el número de estenosis, la naturaleza de las mismas (inflamatorias o fibróticas) y la longitud utilizando enteroresonancia (28) .…”

“…• En estenosis únicas, mayores de 4 cm o múltiples, no se recomienda el uso de dilatación con balón por el mayor riesgo de complicaciones y menor tasa de éxito (28) . • Antes de realizar la dilatación endoscópica se recomienda caracterizar el número de estenosis, la naturaleza de las mismas (inflamatorias o fibróticas) y la longitud utilizando enteroresonancia (28) . • Si hay presencia de fístulas o abscesos cerca del sitio de estenosis, se recomienda no realizar dilatación por el riesgo de perforación (28) .…”

“…• Antes de realizar la dilatación endoscópica se recomienda caracterizar el número de estenosis, la naturaleza de las mismas (inflamatorias o fibróticas) y la longitud utilizando enteroresonancia (28) . • Si hay presencia de fístulas o abscesos cerca del sitio de estenosis, se recomienda no realizar dilatación por el riesgo de perforación (28) . • La cápsula endoscópica es complementaria a la enterografía por resonancia magnética para evaluar la inflamación, las erosiones, las úlceras, el sitio de sangrado, etc., en el intestino medio.…”

Pediatric stricturing Crohn's disease

“…A recent systematic review of population-based studies reported the highest prevalence in Germany (322 per 100000) and Canada (319 per 100000). The incidence of pediatric CD ranges from 2.5–11.4 per 100000 worldwide[ 3 , 4 ]. Common symptoms of CD in children include fever, abdominal pain, bloody or mucopurulent chronic diarrhea, anemia, poor growth, and signs of intestinal obstruction.…”

“…Other symptoms include perianal anomalies, such as abscesses or fistulas, and extraintestinal manifestations like arthritis, erythema nodosum, and uveitis. Notably, despite available treatment strategies for reducing the progressive inflammatory process of the disease, approximately 25% of children with CD develop stricturing CD (SCD) that requires intervention[ 2 , 4 , 5 ]. Approximately 10% of patients present with complicated disease at diagnosis.…”