Role of interventional inflammatory bowel disease in the era of biologic therapy: a position statement from the Global Interventional IBD Group

Shen, Bo; Kochhar, Gursimran; Navaneethan, Udayakumar; Liu, Xiuli; Farraye, Francis A.; González-Lama, Yago; Pardi, Darrell S.; Lukáš, Martin; Bortlík, Martin; Wu, Kaicun; Sood, Ajit; Schwartz, David A.; Sandborn, William J.; Charles, Roger; Chen, Yan; Suárez, Maria Begoña González; Iaccuci, Marietta; Kabayashi, Tako; Kotze, Paulo Gustavo; Li, Nan; Li, Yue; Mao, Ren

doi:10.1016/j.gie.2018.09.045

Cited by 68 publications

(43 citation statements)

References 108 publications

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“…However, the long-term outcome is likely to be more favorable in the surgery group than in the EBD group since EBD requires frequent procedures and has a shorter surgery-free survival. 156,158 EBD is indicated when strictures are ≤ 5 cm long, non-angulated, and without complications such as fistula, abscess, phlegmon, high-grade dysplasia, or malignancy. A stricture length of ≤ 5 cm was related to a longer surgery-free survival, and every-1cm increase in stricture length increased the risk of surgery by 8%.…”

Section: Endoscopic Managementmentioning

confidence: 99%

Fibrostenotic strictures in Crohn’s disease

2020

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reported in 85%-100% of cases 7,10 and fibrostenotic stricture is the most common indication for surgery in CD. 3,9 Surgical resection is related with major morbidity, higher costs, higher risk of unemployment, and poorer quality of life. 3,11,12 Although the introduction of biologics including anti-TNF, anti-integrin, and anti-interleukin (IL) has modified the disease course of CD in the short term, the long-term outcome of those drugs on the development of fibrostenosis and the need for surgery remains to be elucidated. 5 Fibrostenotic strictures were previously considered an inevitable and irreversible consequence of long-term inflammation in CD patients whose conditions are unresponsive to anti-inflammatory therapies. This paradigm has been changing rapidly due to recent advances in our understanding regarding the process of intestinal fibrosis and the introduction of promising candidates for targeted anti-fibrotic therapy. 1 This review aimed to provide a comprehensive overview of fibrostenotic strictures in CD, including mechanisms and factors that predict its progression, as well as diagnosis and treatment strategies. It also introduces promising anti-fibrotic agents for intestinal fibrosis and discuss the obstacles to be overcome in developing clinically available anti-fibrotic agents for CD stricture.

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Section: Endoscopic Managementmentioning

confidence: 99%

Fibrostenotic strictures in Crohn’s disease

2020

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“…The real efficacy of locally injected IFX is not discernible from current literature, but available data seem encouraging at a dose of 100 mg per session, assuming that higher anti-TNF concentrations given through local injection can favor healing and prevent complications, because a trend for a doseresponse curve was observed. Topical injection of anti-TNF agents has been described in the treatment of long-standing perianal fistulizing CD in the absence of an abscess (2). There are technical variations in topical injection of the anti-TNF agents.…”

Section: Discussionmentioning

confidence: 99%

“…Interventional inflammatory bowel disease (IBD) endoscopy has an expanding role in the era of biologic therapy. A significant number of patients have mucosal lesions refractory to biological treatments despite the availability and growing use of antitumor necrosis factor (TNF), anti-integrin, anti-interleukin, and new small-molecule (1,2). These drugs have changed the way of treating IBD patients, but those situations represent unmet needs that require new treatment modalities to prolong the intervention-free period.…”

Section: Introductionmentioning

confidence: 99%

Development and Characterization of a New Endoscopic Drug-Eluting Platform With Proven Efficacy in Acute and Chronic Experimental Colitis

et al. 2020

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Background and Aims: Mucosal lesions refractory to biological treatments represent unmet needs in patients with inflammatory bowel disease (IBD) that require new treatment modalities. We developed and characterized a new endoscopic drug-eluting hydrogel (CoverGel) with proven efficacy in acute and chronic experimental colitis (EC) in rats. Methods: CoverGel was developed based on appropriate rheological, drug release, gelation, structural, and degradation property capacities to allow endoscopic application. Experimental colitis (EC) was induced by TNBS application in rats. In acute EC 40, rats were randomized in five groups (eight each): Sham, Control, CoverGel, CoverGel + Infliximab (IFX) and CoverGel + Vedolizumab (VDZ). In chronic EC, 12 rats were randomized in two groups (six each): IFX s.c. and CoverGel + IFX. Endoscopic, histological, and blood test were performed during follow-up to evaluate clinical success. Antibodies to IFX (ATIs) were evaluated in chronic EC animal study. Results: CoverGel is a biocompatible and bioadhesive reverse thermosensitive gelation hydrogel with a macroporous structure and drug release capacity. In acute EC animals treated with CoverGel + IFX or CoverGel + VDZ showed significantly clinical success (weight recovery, mucosal restoration, and bacterial translocation) as compared with controls and animals without a bioactive drug. In a chronic EC animal study, clinical efficacy was comparable in both groups. Levels of ATIs were significantly lower in animals treated with CoverGel + IFX vs. IFX s.c. (0.90 ± 0.06 µg/mL-c vs. 1.97 ± 0.66 µg/mL-c, p = 0.0025). Conclusions: CoverGel is an endoscopic vehicle to locally deliver biological drugs with proven efficacy in acute and chronic EC in rats and induce less immunogenicity reaction.

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“…They can be secondary to long standing active inflammation resulting in fibrosis and eventual stenosis, ischemia at post-surgical anastomoses, or infectious complications. They are classified based on location, degree of stenosis, length, number, and complexity (ie associated abscess or fistula tract) [17].…”

Section: Balloon Dilationmentioning

confidence: 99%

“…While there are several novel endoscopic techniques emerging for the treatment of endoscopic strictures, surgery remains the preferred approach for patients with multiple strictures, strictures associated with fistula or abscess, and long and angulated strictures [17]. An individualized approach should be taken focusing on the patient's anatomy, goals, and symptoms.…”

Section: New Investigational Therapiesmentioning

confidence: 99%

Advanced Endoscopic Techniques in the Evaluation and Treatment of Fibrostenotic Crohn's Disease

Wong¹,

Lee²

2019

obm hg

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Crohn's disease is characterized by chronic intestinal inflammation that can result in significant morbidity and loss of intestinal function over time. Many novel treatments for Crohn's disease are being developed, but a significant portion of patients still requires surgical therapy for stricturing or penetrating disease. Classically esophagogastroduodenoscopy and ileocolonoscopy have been used to diagnose patients with inflammatory bowel disease and to restage disease after starting or changing therapy. However, new endoscopic techniques are being developed to help evaluate previously inaccessible parts of the small intestine and to treat fibrostenotic complications. This review will focus on video capsule endoscopy, small bowel enteroscopy, endoscopic balloon dilation, as well as other more novel investigational endoscopic therapies for the evaluation and treatment of fibrostenotic complications.

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Role of interventional inflammatory bowel disease in the era of biologic therapy: a position statement from the Global Interventional IBD Group

Cited by 68 publications

References 108 publications

Fibrostenotic strictures in Crohn’s disease

Fibrostenotic strictures in Crohn’s disease

Development and Characterization of a New Endoscopic Drug-Eluting Platform With Proven Efficacy in Acute and Chronic Experimental Colitis

Advanced Endoscopic Techniques in the Evaluation and Treatment of Fibrostenotic Crohn's Disease

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