Systematic Review of Endoscopic Management of Stricture, Fistula and Abscess in Inflammatory Bowel Disease

• Published in: Gastroenterology Insights Vol. 14; no. 1; pp. 45 - 63
• Main Authors: Pal, Partha, Kanaganti, Swathi, Banerjee, Rupa, Ramchandani, Mohan, Nabi, Zaheer, Reddy, Duvvuru Nageshwar, Tandan, Manu
• Format: Journal Article
• Language: English
• Published: Boston MDPI AG 01.02.2023
• Subjects: Abscesses; Biopsy; Care and treatment; Cost analysis; Crohns disease; Crohn’s disease; endoscopic balloon dilation; Endoscopy; Fistula; fistulotomy; Gastrointestinal diseases; Inflammation; Inflammatory bowel disease; Patients; self-expanding metal stent; Stem cells; stricturotomy; Success; Surgery; Systematic review; Tumor necrosis factor-TNF
• ISSN: 2036-7422; 2036-7414; 2036-7422
• DOI: 10.3390/gastroent14010006

Background: Interventional inflammatory bowel disease (IIBD) therapies can play a key role in inflammatory bowel disease (IBD) related stricture/fistula/abscess deferring or avoiding invasive surgery. Methods: A total of 112 studies pertaining to IIBD therapy for strictures/fistula/abscess between 2002 and December 2022 were included by searching Pubmed, Medline and Embase with a focus on technical/clinical success, recurrence, re-intervention and complications. Results: IIBD therapy for strictures include endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES) and self-expanding metal stent (SEMS) placement. EBD is the primary therapy for short strictures while ES and SEMS can be used for refractory strictures. ES has higher long-term efficacy than EBD. SEMS is inferior to EBD although it can be useful in long, refractory strictures. Fistula therapy includes endoscopic incision and drainage (perianal fistula)/endoscopic seton (simple, low fistula) and endoscopic ultrasound-guided drainage (pelvic abscess). Fistulotomy can be done for short, superficial, single tract, bowel-bowel fistula. Endoscopic injection of filling agents (fistula plug/glue/stem cell) is feasible although durability is unknown. Endoscopic closure therapies like over-the-scope clips (OTSC), suturing and SEMS should be avoided for de-novo/bowel to hollow organ fistulas. Conclusion: IIBD therapies have the potential to act as a bridge between medical and surgical therapy for properly selected IBD-related stricture/fistula/abscess although future controlled studies are warranted.