胶囊内镜对老年不明原因消化道出血的诊断及再出血因素分析

目的 评估胶囊内镜对老年不明原因消化道出血的诊断价值，并通过长期随访结果分析其再出血率及其影响因素。方法入选2002年5月至2008年2月间因不明原因消化道出血在本院行胶囊内镜检查的老年患者127例，评估受检患者的耐受性和诊断率，并随访根据诊断结果实施的治疗效果、再出血率及其影响因素。结果127例受检者中阳性诊断率为66．1％，其中以血管病变为最主要诊断，其次为肿瘤和克罗恩病，分别为59．5％、16．7％和11．9％。剔除10例失访者后，经随访发现117例中再出血率为41％，其中阳性诊断组为48-8％（38／78），阴性诊断组为25．7％（10／39），两组具有统计学差异（P〈0．05）；而阳性诊断组中非血管病变者再出血率为24．2％（8／33），血管病变者为66．7％（30／45），同样具统计学差异（P〈0．01）。结论胶囊内镜对于老年不明原因消化道出血患者是一项安全有效的检查手段。胶囊内镜诊断中以非血管性病变及阴性者再出血率低，而血管病变者再出血率高。

Diagnostic value of capsule endoscopy in elderly patients with obscure GI bleeding and analysis of factors for rebleeding

Objective To evaluate the diagnostic value of capsule endoscopy （CE） in elderly patients with obscure GI bleeding, and analyze factors for rebleeding through long-term follow-ups. Methods Included in the present study were 127 elderly patients with OGIB referred to our hospital for CE between May 2002 and February 2008. Patient tolerance to CE and the diagnostic rate were observed. The outcome, rebleeding and factors affecting rebleeding were analyzed through long-term follow-ups. Results The overall diagnostic Tate of CE was 66.1% in 127 patients with OGIB. The most common findings were vascular lesions, including angiodysplasia （59.5%）, neoplasia （16.7%） and Crohn＇s disease （11.9%）. Bleeding recurrence was found in 41% of 117 patients during the follow-up, and the remaining 10 patients we.re lost to the follow-up. The rebleeding rate was significantly higher in patients with positive CE than in those with negative CE （48.8% vs 25.7%, P〈0.05）. In patients with positive CE findings, the rebleeding rate in non angiodysplasic patients was 24.2% （8/33） versus 66.7 % （30/45） in angiodysplasic patients （P 〈 0.01）. Conclusion Capsule endoscopy is a safe and effective procedure for elderly patients with OGIB. The rebleeding rate was lower in non angiodysplasic and CE negative patients than that in angiodysplasic patients.