@article{oai:shiga-med.repo.nii.ac.jp:00003492,
 author = {馬場, 重樹 and 安藤, 朗 and BAMBA, Shigeki and SAKEMI, Ryosuke and FUJII, Toshimitsu and TAKEDA, Teruyuki and FUJIOKA, Shin and TAKENAKA, Kento and KITAMOTO, Hiroki and UMEZAWA, Shotaro and SAKURABA, Hirotake and INOKUCHI, Toshihiro and FUKATA, Norimasa and MIZUNO, Shinta and YAMASHITA, Masaki and SHINZAKI, Shinichiro and TANAKA, Hiroki and TAKEDATSU, Hidetoshi and OZAKI, Ryo and MORIYA, Kei and ISHII, Manabu and KINJO, Tetsu and OZEKI, Keiji and OOI, Makoto and HAYASHI, Ryohei and KAKIMOTO, Kazuki and SHIMODATE, Yuichi and KITAMURA, Kazuya and YAMADA, Akihiro and SONODA, Akira and NISHIDA, Yu and YOSHIOKA, Kyouko and ASHIZUKA, Shinya and TAKAHASHI, Fumiaki and SHIMOKAWA, Toshio and KOBAYASHI, Taku and ANDOH, Akira and HIBI, Toshifumi},
 issue = {6},
 journal = {Journal of Gastroenterology},
 month = {Jan},
 note = {BACKGROUND:
Small bowel stricture is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD., METHODS:
Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available., RESULTS:
A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of ≤ 446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation., CONCLUSIONS:
In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD., Journal Article},
 pages = {615--626},
 title = {A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn's disease.},
 volume = {55},
 year = {2020}
}