Non-conventional versus conventional strictureplasties for Crohn's disease. A Systematic Review and Meta-analysis of Treatment Outcomes.

Background Strictureplasties (SXP) represents an alternative to bowel resection in Crohn's disease (CD). Over the years, there has been growing interest in the role of non-conventional SXP for the treatment of extensive CD. A systematic review was performed on complications and recurrence of conventional and non-conventional SXP. Methods The available literature was screened according to the PRISMA statement until June 2020. Results were categorized into three groups: studies reporting on conventional SXPs; studies with a mixed cohort of conventional and non-conventional SXPs (% non-conventional SXPs ≤15%), and studies reporting on non-conventional SXPs. Considered endpoints were postoperative complications, and overall and SXP site-specific surgical recurrence. Random effect meta-analysis and meta-regression were used to obtain and compare combined estimates between groups. Results A total of 26 studies for a total of 1839 patients with CD were included. The pooled postoperative complication rate was 15.5% (95% CI 11.2%-20.3%), 7.4% (95% CI 0.2%-22.9%), and 19.2% (95% CI 5-39.6%). The rate of septic complications was 4% (95% CI 2.2%-6.2%), 1.9% (95% CI 0.4%-4.3%), and 4.2% (95% CI 0.9%-9.8%). Cumulative overall surgical recurrence was 27.5% (95% CI 18.5%-37.6%), 13.2% (95% CI 8.6%-18.7%), and 18.1% (95% CI 6.8%-33.3%) and SXP site-specific surgical recurrence was 13.2% (95% CI 6.9%-21.2%), 8.3% (95% CI 1.6-19.3%), and 8.8% (95% CI 2.2%-19%). Formal comparison between the groups revealed no differences. Conclusion Non-conventional SXP did not differ to conventional SXP with respect to safety and long-term recurrence. Consistent heterogeneity was observed and partially limits the conclusion of this study.