Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India
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....
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-12-01
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| Series: | Journal of Digestive Endoscopy |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757470 |
| _version_ | 1811197664712196096 |
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| author | Partha Pal Mohan Ramchandani Rupa Banerjee Pradev Inavolu Zaheer Nabi Hardik Rughwani Aniruddha Pratap Haripal Singh Rajendra Patel Polina Vijayalaxmi Jagdeesh Rampal Singh Pradeep Rebala Guduru Venkat Rao D Nageshwar Reddy Manu Tandan |
| author_facet | Partha Pal Mohan Ramchandani Rupa Banerjee Pradev Inavolu Zaheer Nabi Hardik Rughwani Aniruddha Pratap Haripal Singh Rajendra Patel Polina Vijayalaxmi Jagdeesh Rampal Singh Pradeep Rebala Guduru Venkat Rao D Nageshwar Reddy Manu Tandan |
| author_sort | Partha Pal |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T01:17:57Z |
| format | Article |
| id | doaj.art-9909c58b77a041fdb9579a931b36803e |
| institution | Directory Open Access Journal |
| issn | 0976-5042 0976-5050 |
| language | English |
| last_indexed | 2024-04-12T01:17:57Z |
| publishDate | 2022-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Digestive Endoscopy |
| spelling | doaj.art-9909c58b77a041fdb9579a931b36803e2022-12-22T03:53:53ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Digestive Endoscopy0976-50420976-50502022-12-01130420721710.1055/s-0042-1757470Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in IndiaPartha Pal0Mohan Ramchandani1Rupa Banerjee2Pradev Inavolu3Zaheer Nabi4Hardik Rughwani5Aniruddha Pratap Haripal Singh6Rajendra Patel7Polina Vijayalaxmi8Jagdeesh Rampal Singh9Pradeep Rebala10Guduru Venkat Rao11D Nageshwar Reddy12Manu Tandan13Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaBackground/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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757470interventional inflammatory bowel diseaseendoscopic balloon dilationendoscopic stricturotomyenteroscopycolitis-associated neoplasiaendoscopic mucosal resectionendoscopic submucosal dissection |
| spellingShingle | Partha Pal Mohan Ramchandani Rupa Banerjee Pradev Inavolu Zaheer Nabi Hardik Rughwani Aniruddha Pratap Haripal Singh Rajendra Patel Polina Vijayalaxmi Jagdeesh Rampal Singh Pradeep Rebala Guduru Venkat Rao D Nageshwar Reddy Manu Tandan Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India Journal of Digestive Endoscopy interventional inflammatory bowel disease endoscopic balloon dilation endoscopic stricturotomy enteroscopy colitis-associated neoplasia endoscopic mucosal resection endoscopic submucosal dissection |
| title | Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India |
| title_full | Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India |
| title_fullStr | Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India |
| title_full_unstemmed | Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India |
| title_short | Role of Interventional Inflammatory Bowel Disease (IBD) in the Management of Complex IBD: Initial Prospective Experience from a Tertiary Center in India |
| title_sort | role of interventional inflammatory bowel disease ibd in the management of complex ibd initial prospective experience from a tertiary center in india |
| topic | interventional inflammatory bowel disease endoscopic balloon dilation endoscopic stricturotomy enteroscopy colitis-associated neoplasia endoscopic mucosal resection endoscopic submucosal dissection |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1757470 |
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