胶囊内镜检查对小肠疾病的诊断价值

目的 评估胶囊内镜在小肠疾病诊断中的应用价值。方法 对经胃镜、全结肠镜、小肠镜、全消化道钡餐检查、腹部血管造影等检查无阳性发现的23例病变疑在小肠的患者，应用胶囊内镜进行小肠检查，评估胶囊内镜检查在小肠疾病诊断中的应用价值。结果 23例患者进行了24次胶囊内镜检查，1例因胶囊内镜滞留在食管下段而进行第2次检查，检查过程中患者无任何不适。23例中20例发现病变，病变检出率为86．8％，其中4例存在2种病变。小肠炎症性疾病10例，血管病变9例，黏膜下结节2例，憩室2例，问质细胞瘤1例。19次胶囊内镜向前摄影，4次向后摄影。17例通过回盲瓣进入盲肠(73．9％)。结论 胶囊内镜小肠黏膜摄影图像清晰，检查安全方便，病变检出率高，有很好的临床应用价值。

Study on capsule endoscopies in diagnosing small bowel diseases

Objective To evaluate the diagnostic potential of capsule endoscopies (CE) for suspected small bowel diseases. Methods From September 2002 to June 2003, 23 patients (12 males, 11 females ) , age ranged 10 to 75 years old, with suspected small bowel diseases, were referred to our department to perform CE using Given M2A Video Capsule System. All patients had undergone previous negative endo-scopic evaluation at least once with esophago-gastro-duodenoscopy and total colonoscopy. Additional diagnostic work-up including small bowel enteroclysis, selective angiography, scintigraphy and puch enteroscopy, were performed, totally 36 procedures. Two endoscopists independently reviewed capsule images to arrive a consensus diagnosis. The initial diagnostic yield was quantified, and the value of CE was assessed. Of the 23 patients, 18 suffered from obscure gastrointestinal bleeding, 3 abdominal pain, and 2 chronic diarrhea. Results Twenty-four studies in 23 patients were evaluated. During CE patients have not complained of any uncomfortable feeling, only one patient had repeated the procedure because the capsule lodged at the inferior segment of esophagus near the Z line. Of the 23 patients, 20 had positive findings with a diagnostic yield of 86. 8% . The positive findings included inflammatory lesions in 10 patients (Crohns disease 7 , aphthous ulcer 3 ) , vascular abnormalities 9 ( phlebectasis 6, angioma 2, angiodysplasia 1) , submucosal nodulation 2 , diverticula 2, jejunal stromal tumor 1. Four of 23 patients had more than one lesion. Diagnosis of 6 patients was confirmed by surgery and /or pathology. Nineteen capsules passed in the direction with the camera facing forward, while the other 4 backward. Generally, it delayed in passing through the pylorus and ileocecal valves. Capsules reached cecum in 17 patients (73. 9% ) . Conclusion CE provided clearly the small intestinal images, and is an efficient tool in diagnosing small bowel diseases with a high diagnostic yield.