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Background <p>Various endoscopic and interventional techniques have been employed in the management of benign colorectal strictures (BCS), but the optimal treatment strategy has not been established. In this real-world study, we divided the patients into four groups based on different treatment regimens: large balloon first (LB group), small balloon first (SB group), stent first (Stent group), and endoscopic incision first (EI group).</p> Purpose <p>We aimed to compare the difference in the clinical outcomes and cost-effectiveness of each method to explore the possible optimal therapeutic strategy.</p> Methods <p>A total of 76 patients with BCS were retrospectively studied between October 2012 and February 2025. In the LB group, 15 patients were treated by means of large balloon (diameter: 20–26&#xa0;mm) dilation first, while in the SB group 32 patients underwent dilation with small balloon (diameter: 10–18&#xa0;mm) dilation first. Seventeen patients in the Stent group preferred stent placement as the first treatment, while 12 patients in the EI group preferred endoscopic incision, with or without balloon dilation. The technical and clinical success, number of treatment sessions, complications, disease-free time intervals, and the hospitalization cost were evaluated and compared.</p> Results <p>The technical success rates range from 71.4% to 92.3%. Recurrence of stricture and colorectal perforation were the main reasons for technical failures. After dilation, stricture length and stricture rates decreased significant, and stricture diameter increased significant in LB Group (<i>P</i> &lt; 0.0001). Mild bleeding and abdominal pain were the common minor complications occurred in either group. Colorectal perforations occurred in 6 dilations: 2 (7.7%) in the LB group, 3 (5.3%) in the SB group and 1 (2.2%) in the EI group (<i>P</i> = 0.2629), respectively. Stent-related complications were observed in 8 patients (47.1%) and 13 sessions (44.8%) in the Stent group. A total of 29 patients (38.2%) were clinically cured: 7 (46.7%) in the LB group, 16 (50.0%) in the SB group, 3 (17.6%) in the Stent group and 3 (25.0%) in the EI group (<i>P</i> = 0.1223), respectively. More treatment sessions and more hospitalization cost were observed in the Stent group (<i>P</i> &lt; 0.05). There was no statistically significant difference in the number of hospitalization, treatment duration, or median interval to recurrence among the four groups.</p> Conclusion <p>Balloon dilation, stenting and endoscopic incision are safe and effective methods for the treatment of BCS. However, stent placement first with/without dilation, associated with more treatment sessions, increased hospitalization cost and stent-related complications, should not be the preferred treatment for BCS, primarily anastomotic BCS.</p>

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A real-world study of endoscopic and fluoroscopic management of benign colorectal strictures: clinical and cost-effectiveness outcomes

  • 期刊论文

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  • 发表日期：

    2025年11月26日

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  • Yuyan Liu,
  • Guangshao Cao,
  • Yonghua Bi,
  • Ping Liu,
  • Xinwei Han

摘要

Background

Various endoscopic and interventional techniques have been employed in the management of benign colorectal strictures (BCS), but the optimal treatment strategy has not been established. In this real-world study, we divided the patients into four groups based on different treatment regimens: large balloon first (LB group), small balloon first (SB group), stent first (Stent group), and endoscopic incision first (EI group).

Purpose

We aimed to compare the difference in the clinical outcomes and cost-effectiveness of each method to explore the possible optimal therapeutic strategy.

Methods

A total of 76 patients with BCS were retrospectively studied between October 2012 and February 2025. In the LB group, 15 patients were treated by means of large balloon (diameter: 20–26 mm) dilation first, while in the SB group 32 patients underwent dilation with small balloon (diameter: 10–18 mm) dilation first. Seventeen patients in the Stent group preferred stent placement as the first treatment, while 12 patients in the EI group preferred endoscopic incision, with or without balloon dilation. The technical and clinical success, number of treatment sessions, complications, disease-free time intervals, and the hospitalization cost were evaluated and compared.

Results

The technical success rates range from 71.4% to 92.3%. Recurrence of stricture and colorectal perforation were the main reasons for technical failures. After dilation, stricture length and stricture rates decreased significant, and stricture diameter increased significant in LB Group (P < 0.0001). Mild bleeding and abdominal pain were the common minor complications occurred in either group. Colorectal perforations occurred in 6 dilations: 2 (7.7%) in the LB group, 3 (5.3%) in the SB group and 1 (2.2%) in the EI group (P = 0.2629), respectively. Stent-related complications were observed in 8 patients (47.1%) and 13 sessions (44.8%) in the Stent group. A total of 29 patients (38.2%) were clinically cured: 7 (46.7%) in the LB group, 16 (50.0%) in the SB group, 3 (17.6%) in the Stent group and 3 (25.0%) in the EI group (P = 0.1223), respectively. More treatment sessions and more hospitalization cost were observed in the Stent group (P < 0.05). There was no statistically significant difference in the number of hospitalization, treatment duration, or median interval to recurrence among the four groups.

Conclusion

Balloon dilation, stenting and endoscopic incision are safe and effective methods for the treatment of BCS. However, stent placement first with/without dilation, associated with more treatment sessions, increased hospitalization cost and stent-related complications, should not be the preferred treatment for BCS, primarily anastomotic BCS.