Indirect comparison of endoscopic balloon dilatation, stent placement, and stricturotomy for lower gastrointestinal strictures in Crohn’s disease: a systematic review and meta-analysis

Background and aims Outcomes of endoscopic balloon dilatation (EBD), endoscopic stent placement (ESP), and endoscopic stricturotomy for Crohn’s disease-related strictures vary across studies. We conducted an indirect meta-analysis to synthesize and compare outcomes. Methods Data were extracted from multiple online databases. Primary outcomes of interest were: clinical success and technical success. Secondary outcomes of interest were: rate of adverse events, the rates of repeat endoscopic procedures, and surgery. Pooled proportions along with 95% confidence interval (CI) and odds ratio (OR) of each outcome were calculated. Results We analyzed 39 studies: 25 on EBD ( n = 1353), nine on ESP ( n = 159), and five on endoscopic stricturotomy ( n = 102). Pooled outcomes for EBD, ESP, and endoscopic stricturotomy, respectively, were: technical success (88, 93, and 95%), clinical success (62, 59, and 49%), adverse events (7, 25, and 17%), repeat procedures (17, 7, and 56%), and surgery (13, 25, and 9%). Compared with EBD, endoscopic stricturotomy showed significantly higher repeat endoscopy rates (OR = 6.165, 95% CI: 2.328–6.328, P < 0.05). Both endoscopic stricturotomy and ESP had higher adverse event rates than EBD (endoscopic stricturotomy: OR = 2.610, 95% CI: 1.095–6.221; ESP: OR = 4.214, 95% CI: 2.070–8.579; both P < 0.05). Differences in clinical and technical success, repeat procedures with ESP, and surgery were NS. Conclusion Clinical and technical success were not significantly different between EBD, ESP, and endoscopic stricturotomy for Crohn’s disease-related strictures. However, adverse events and repeat procedures were higher in ESP and endoscopic stricturotomy when compared with EBD.