Table 1.
Summary of Study Details from Literature Review of Medical Therapy of Strictures
| First Author, Year of Publication | Country | Study Design | Number of Patients | Number of Strictures | Stricture Definition (endoscopy/radiology/clinical) | Small Bowel Stricture Location | Follow Up Period | Drug | Surgery | Endoscopic Dilation | Treatment Change |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Amitai, 2018 | Israel | R | 21 | No comment | MRE - wall thickening and luminal narrowing with prestenotic dilatation with a bowel diameter greater than the normal diameter of the bowel. If > 1 stricture, most severe distal ileal stricture was evaluated. | Terminal ileum | 12 months | ADA or IFX | 23.8% (5/21) | 4.7% (1/21) | 14.3% (3/21) |
| Bouhnik, 2018 (CREOLE) | France | P | 97 | ≥ 1 stricture/patient | MRE/endoscopy - constant luminal narrowing with prestenotic dilatation or obstructive signs/symptoms. | duodenum, jejunum or ileum | 24 weeks | ADA | 8.2% (8/97) | 2.0% (2/97) | 36.0% (35/97) |
| Campos, 2017 | France | R | 84 | 13/55 with DI | Obstructive symptoms. CDOS | Ileum, ileocolonic | 60 months | ADA or IFX | 31.0% (26/84) | N/A | N/A |
| Condino, 2013 | Italy | P | 36 (9 fibrostenotic; 2 ileum, 1 ileocolonic) | No comment | SICUS assessment (bowel wall thickness, lumen diameter, bowel dilation and lesion extent) | Ileum, ileocolonic | 23 months | ADA or IFX | 22.2% (2/9) | N/A | N/A |
| De Souza, 2013 | Brazil | RCT | 72 | 1/patient | Obstructive symptoms. X-ray and CT obstruction without abscess. | ileocolonic | 36 months | AZA or mesalamine 3.2 g/day | Mesalamine, 56% (19/34). AZA, 25% (8/32) | N/A | N/A |
| Gibson, 2015 | Ireland | R | 75; 18 fibrostenotic | Not specified | MRE - Small bowel stenosis with or without prestenotic dilatation where stenosis was defined as a reduction of the bowel lumen (diameter ≥80%) lower than that measured in a normal adjacent nonprestenotic loop | Small bowel; not specified | 16.7 months | ADA or IFX | 66.7% (12/18) | N/A | N/A |
| Kim, 2016. | Korea | R | 28 (fibrostenosis on AZA) | Not specified | Imaging or endoscopy | Not specified | 105.8 months | AZA | 24.1% | N/A | N/A |
| Pallotta, 2008 | Italy | P | 15 | 15; 8 patients with 1 stricture, 1 patient with 3 strictures, 1 patient with 4 strictures | Obstructive symptoms, endoscopy - stricture confirmed with inability to pass 11 mm caliber endoscope in terminal and neoterminal ileum, MRI and SICUS. Lumen diameter < 1 cm, measured at the level of maximally distended loop, independent of the presence of prestenotic dilatation; and bowel dilatation - lumen diameter more than 2.5 cm. Regression of stenosis - intestinal lumen with diameter > 1cm on at least 2 follow up SICUS, and confirmed at endoscopy, or MRI for more proximal small bowel stenoses. | 4 Neoterminal ileum, 1 Proximal ileum, 4 Terminal ileum, 1 upper GI tract. | 35 months | IFX | 10% (1/10) | N/A | N/A |
CDOS – Crohn’s disease obstructive score. CT – computed tomography. DI – diagnostic imaging. ADA – adalimumab, AZA – azathioprine, IFX – infliximab. MTX – methotrexate. 6MP- mercaptopurine. R –retrospective. P – prospective. RCT – randomized controlled trial, SASA – sulfasalazine. SICUS – small intestinal contrast ultrasound.