Bypass is associated with lower treatment failure than stricturoplasty in duodenal Crohn's disease: a systematic review with pairwise and network meta-analyses.

Background
Crohn's disease (CD) of the duodenum is uncommon, with the goal of treatment often being avoidance of surgery. However, as many as one-third of these patients will eventually require surgery for their disease. This study aimed to compare outcomes and safety of surgical treatments for duodenal CD.
Methods
In this meta-analysis, a search was conducted for studies that reported outcomes of surgical treatment of duodenal CD. The primary outcome was treatment failure. Secondary outcomes were postoperative complications and reoperation rate.
Results
10 studies published between 1970 and 2023, including 325 patients with predominately stricturing duodenal CD, were included. Bypass was the surgical treatment for 155 (68.6%) patients followed by stricturoplasty (21.7%) and resection (8.4%). Pairwise meta-analyses revealed that the only significant finding was a lower rate of treatment failure in favor of bypass when compared to stricturoplasty (OR: 0.41, 95% CI: 0.18; 0.95, p = 0.038) with similar odds of complications and reoperation among the 3 operations. In the network meta-analysis, bypass ranked the best with lowest failure, complication, and reoperation rates. Stricturoplasty was followed by a significantly higher rate of failure compared to bypass (OR: 2.51, 95% CI: 1.10; 5.27, p = 0.028,).
Conclusion
Among the three procedures, surgical bypass ranked best with lowest failure, complications, and reoperation rates. While bypass was associated with lower failure than stricturoplasty, both procedures were associated with similar complication and reoperation rates. The authors propose surgical bypass as a safe and effective option for the treatment of stricturing duodenal CD.