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Abstract
Background Crohn’s disease (CD) with intestinal obstruction often necessitates emergency surgery when conservative treatments fail. This study assesses the feasibility, safety, and efficacy of treatments based on colonic transendoscopic enteral tubing (TET) as an alternative intervention.
Methods In this prospective, single-center interventional study, patients with CD and inflammatory intestinal obstruction, refractory to conservative treatments, underwent colonic TET-based treatments. The interventions via colonic TET comprised washed microbiota transplantation (WMT), with or without the administration of steroids, depending on the presence of evident colonic inflammatory lesions in patients. The primary outcome assessed exclusive enteral nutrition (EEN) tolerance rate following treatments through colonic TET. Secondary outcomes evaluated changes in laboratory indicators, obstruction score, and the Harvey-Bradshaw Index (HBI). The study also examined three crucial hospitalization periods, the safety, and treatment modalities three months later.
Results The study analyzed 13 patients from March 2018 to May 2023 (IDDF2024-ABS-0179 Figure 1 Flow chart). All of these patients were unable to tolerate EEN following conservative treatments (IDDF2024-ABS-0179 Figure 2 Clinical protocol for Crohn’s disease with intestinal obstruction). Among them, 92.3% (12/13) successfully tolerated EEN after colonic TET. The average interval from colonic TET to initiation of EEN is 7.9 ± 4.7 days (IDDF2024-ABS-0179 Figure 3 Outcomes). All patients underwent WMT, with those showing evident colonic inflammation (n = 6) receiving local steroids via colonic TET (IDDF2024-ABS-0179 Figure 4 Colonic TET placement varies based on individual patient conditions). Post-treatment, improvements (IDDF2024-ABS-0179 Figure 3 Outcomes) were observed in C-reactive protein (p<0.01), hemoglobin (p<0.01), pre-albumin (p<0.01), obstruction score (p<0.01), and HBI (p<0.001). All 13 patients completed a 3-month follow-up without requiring emergency surgery, and no severe adverse events occurred.
Flow chart
Clinical protocol for Crohn’s disease with intestinal obstruction
Outcomes
Colonic TET placement varies based on individual patient conditions
Conclusions Colonic TET proves a novel and safe endoscopic intervention for CD with intestinal obstruction, providing a vital transition from urgency to stability. This technique enables patients to explore safer treatment options, presenting a new avenue in interventional inflammatory bowel disease.