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CC BY 4.0 · Journal of Digestive Endoscopy 2022; 13(04): 207-217
DOI: 10.1055/s-0042-1757470
Research Article

Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India

Partha Pal
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Mohan Ramchandani
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Rupa Banerjee
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Pradev Inavolu
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Zaheer Nabi
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Hardik Rughwani
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Aniruddha Pratap Haripal Singh
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Rajendra Patel
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Polina Vijayalaxmi
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Jagdeesh Rampal Singh
2   Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Pradeep Rebala
3   Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Guduru Venkat Rao
3   Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
D Nageshwar Reddy
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
,
Manu Tandan
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Abstract

Background/Aims With the growing multidisciplinary model of practice in the management of complex inflammatory bowel disease (IBD) and rising incidence of IBD, interventional IBD (IIBD) promises to play a key role. We aimed to evaluate current the role of IIBD in India and its short-term outcomes.

Methods IBD patients undergoing IIBD procedures for stricture, bleeding, colitis-associated neoplasia, therapeutic small bowel endoscopy including retained capsule retrieval and postsurgical complications were enrolled prospectively between September 2021 and May 2022. Demographic and disease details, indications, initial and redo procedure details, technical/clinical success, and complications were recorded.

Results IIBD procedures were performed in total 54 patients (61% males, median age: 37.5 years, range: 21–74 years, Crohn's disease [CD]: 42, ulcerative colitis [UC]: 12 between September 2021 and April 2022). Endoscopic balloon dilation (EBD) was performed in 44 patients (56 strictures, 9% anastomotic, 9% pouch) who underwent total 83 EBD procedures in 63 sessions. Short-term clinical efficacy after maximal dilation, technical success (i.e., scope passage after EBD), and complications (all mild) were noted in 95.4, 81.8, and 9.1%, respectively. Recurrent symptoms were seen in 27.3% on short-term follow-up (1–8 months, median: 5 months) for which redilation, surgery, and endoscopic stricturotomy were done in 22.7, 2.3, and 2.3% respectively. During small bowel EBD, motorized spiral enteroscopy-guided retained capsule endoscope retrieval was done in four patients. Ulcerative colitis-associated neoplasia (UCAN) was resected endoscopically in six patients (endoscopic submucosal dissection (ESD)—1, endoscopic mucosal resection (EMR)—5). High-grade dysplasia was resected in two patients (1 ESD for recurrent UCAN, 1 EMR had residual neoplasia on follow-up treated with underwater EMR). R0 resection was achieved in 83.3%. Endoscopic hemostasis was done with hemoclipping and sclerotherapy for UC-related bleeding in two, whereas a case of CD with proximal ileal bleeding was controlled with antegrade single-balloon enteroscopy-assisted hemoclipping.

Conclusions IIBD is a promising modality in resource-limited settings like India acting as a bridge between medical therapy and surgery. Surgery can be avoided in a significant proportion with good short-term outcomes. Long-term outcomes need to be evaluated.

Keywords

interventional inflammatory bowel disease - endoscopic balloon dilation - endoscopic stricturotomy - enteroscopy - colitis-associated neoplasia - endoscopic mucosal resection - endoscopic submucosal dissection


Publication History

Article published online:
15 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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