双气囊小肠镜诊断小肠肿瘤3例报告

我院于2007年7月引进日本富士能EN-450PS/28双气囊小肠镜(DBE),目前已有28例患者接受该项检查,其中发现小肠肿瘤患者3例,报道如下.     

双气囊小肠镜与胶囊内镜诊断小肠出血病因比较

目的比较双气囊小肠镜和胶囊内镜在小肠出血中的诊断准确率和实用价值。方法24例原因不明的可疑小肠出血患者分别接受双气囊小肠镜和胶囊内镜检查。双气囊小肠镜首选进镜方式分为经口或经肛2种，首选方式检查后未发现病灶者，日后改换进镜方式再行检查。胶囊内镜采用以色列GIVEN公司产品。2种检查方法分别由专门医师独立操作并诊断，最后进行汇总比较。结果24例患者中21例通过小肠镜检查发现病灶，总检出率为87．5％。24例患者行胶囊内镜检查后，有阳性发现者11例(45．8％)，另13例无异常发现。双气囊小肠镜检查发现的阳性病灶均经活检病理和手术探查证实，其病因诊断准确率为87．5％，胶囊内镜诊断准确率为25％。在耐受性评估方面，胶囊内镜和全麻下经口进镜的耐受性最佳，以后依次为非麻醉经肛方式和非麻醉经口方式。所有小肠镜和胶囊内镜检查者中未见操作相关的严重不良反应。结论①经口和经肛方式结合能使双气囊小肠镜完成对全小肠的检查。②双气囊小肠镜在不明原因小肠出血的病因诊断方面明显优于胶囊内镜检查。③胶囊内镜在小肠多节段病变和长段病变的诊断上仍有一定价值。④胶囊内镜和全麻下经口双气囊小肠镜检查是一项易为患者接受的、安全的检查方法。     

双气囊小肠镜与胶囊内镜在小肠出血应用中的对比研究

目的比较双气囊小肠镜与胶囊内镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,初步探讨双气囊小肠镜对小肠出血的内镜下治疗。方法2006年4月至2009年10月烟台毓璜顶医院消化内科收治的可疑小肠出血患者159例,其中81例患者行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查。对活动性出血病灶行内镜下止血治疗。另78例患者行胶囊内镜检查。两组患者分别由专门医师独立操作并诊断,最后进行汇总分析,对比双气囊小肠镜与胶囊内镜的临床应用价值。结果双气囊小肠镜组的病变检出率为95.06%,病因诊断率为82.72%,23例检查时见病变活动性出血,行内镜下止血治疗,21例止血成功,内镜止血成功率为91.30%;胶囊内镜组的病变检出率82.05%,病因诊断率为66.67%。双气囊小肠镜组的病因检出率及病因诊断率均显著高于胶囊内镜组,差异有统计学意义(P0.05)。在耐受性方面,胶囊内镜的耐受性最好,双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜。所有患者均未发生严重并发症。结论双气囊小肠镜对小肠出血的病因诊断明显优于胶囊内镜,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法。     

胶囊内镜序贯联合双气囊小肠镜诊断小肠出血

目的评价胶囊内镜(capsule endoscopy,CE)序贯联合双气囊小肠镜(double-balloon enteroscopy,DBE)检查对小肠出血疾病(small intestine bleeding,SIB)的临床诊断价值。方法回顾性分析106例行CE检查及部分序贯联合DBE检查SIB患者的临床资料。结果 106例SIB患者病因明确诊断率为96.2%(102/106),以肠黏膜糜烂、溃疡性病变25.5%(27/106)、血管病变24.5%(26/106)、小肠肿瘤、隆起病变23.6%(25/106)最常见;行CE和DBE检查的病变检出率分别为89.6%(95/106)、96.2%(50/52),病因诊断率分别为50.9%(54/106)、92.3%(48/52),DBE检查病因诊断率显著高于CE检查,差异有统计学意义(P0.01);CE和DBE检查发现血管病变、肿瘤隆起病变与憩室分别为22.6%(24/106)、0.9%(1/106)和51.9%(27/52)、15.4%(8/52),DBE对血管病变、肿瘤隆起病变与憩室病因的诊断率高于CE,二者比较差异有统计学意义(P0.05)。结论在小肠出血患者中CE检查对血管病变、肿瘤隆起病变与憩室的病因诊断低于DBE检查;CE序贯联合DBE检查应用能提高小肠出血疾病的病变检出率及病因诊断率。     

双气囊电子小肠镜检查小肠疾病62例

目的:评价双气囊小肠镜对小肠疾病诊断价值及其安全性和操作性能,增加小肠疾病的检出率.方法:2005-08/2006-12期间62例有消化道症状,经胃镜、结肠镜、全消化道钡餐、腹部CT等检查无阳性发现的患者应用双气囊电子小肠镜检查,结合手术、病理结果、观察、分析其阳性率、检查范围、并发症等,所有检查均在静脉麻醉下完成.结果:62例患者中仅有5例发生轻度呼吸抑制、血压下降等麻醉相关的并发症:检查过程除了咽喉损伤、黏膜擦伤外无严重并发症发生.62例患者通过双气囊小肠镜检查发现有病变者53例,病变检出率85.5%;其中肿瘤性疾病10例,占18.9%(10/53);炎症性疾病包括炎症性肠病和非特异性糜烂、溃疡20例,占37.7%(20/53);血管性疾病7例,占13.2%(7/53);寄生虫病6例,占11.3%(6/53);其他10例,占18.9%(10/53);未发现病灶9例.结论:双气囊小肠镜可直视检查全消化道腔内病变,对消化道特别是小肠病变检出率高,是诊断和治疗小肠疾病的有力工具.     

双气囊小肠镜对小肠出血的诊断价值研究

目的通过双气囊小肠镜对不明原因的小肠出血疾病进行病因分析。方法回顾性分析2008年10月至2014年1月我院应用双气囊小肠镜对小肠出血疾病患者进行检查,并分析消化道出血的病因组成。结果 163名患者接受173例次小肠镜检查,经口进镜检查59例次,经肛门进镜检查104例次,经口及经肛门两端进镜检查10例,检查成功率100%,其中阳性病例134例(77.46%),所有患者未发生出血、穿孔、梗阻等不良反应和相关并发症。结论小肠出血的病因诊断较困难,目前双气囊小肠镜是诊断小肠出血有价值、安全可靠的检查方法。     

双气囊小肠镜对小肠疾病的诊断价值

目的评价双气囊小肠镜对小肠疾病的诊断价值。方法使用Fujinon双气囊小肠镜对我院2011年1月～2012年7月间拟诊小肠疾病的186例患者进行检查。43例患者经口进镜检查,69例患者经肛进镜检查,36例患者经口+经肛进镜检查。镜下可疑病变常规进行组织病理活检。结果 186例双气囊小肠镜检查共发现小肠病变164例,阳性率达88.2%。发现小肠肿瘤性病变28例(炎性息肉14例,间质瘤5例,黄色瘤5例,错构瘤1例,小肠腺癌1例,十二指肠恶性淋巴瘤1例,胃肠息肉病1例)。小肠炎症性病变108例,其中小肠克罗恩病17例,小肠非特异性炎症91例。小肠寄生虫病5例(包括钩虫、鞭虫)。小肠憩室13例,其中确诊小肠Meckels憩室出血1例。小肠外压性狭窄8例。小肠异物2例,均通过小肠镜异物钳成功取出异物。成功行回盲部溃疡出血小肠镜下钛夹止血治疗1例。尚未发生出血、穿孔、胰腺炎等并发症。结论双气囊小肠镜能安全、准确地检查全段小肠,并能对可疑病变取活检,明显提高了诊断的准确性及阳性率,对小肠疾病的诊断有很大应用价值。     

双气囊电子小肠镜在小肠狭窄诊断中的作用

目的:比较双气囊电子小肠镜及小肠钡灌检查在疑有小肠狭窄患者中病变的检出率和诊断率,评价双气囊电子小肠镜在小肠狭窄诊断中的价值及安全性.方法:疑患小肠疾病患者76例,行双气囊电子小肠镜检查,分别经口或经肛进镜,对未检出病灶者建议择期改换进镜方式再行检查;其中疑小肠狭窄患者13例均行小肠钡灌检查.比较2种检查方法在疑小肠狭窄患者中病变的检出率、诊断率.结果:疑有小肠狭窄患者13例中有8例经口、3例经肛、2例分别经口和经肛行双气囊电子小肠镜检查,检查所用平均时间74(55-120)min,小肠狭窄病变检出率为84.6%(11/13),其中小肠肿瘤6例,克罗恩病3例,炎性狭窄2例.检出病变中双气囊电子小肠镜诊断率为69.2%(9/13),所有患者均未发生严重不良反应和并发症.疑小肠狭窄患者小肠钡灌检查的病变检出率为53.8%(7/13),其中小肠肿瘤3例,克罗恩病2例,炎性狭窄2例.在小肠钡灌检查未发现异常的6例病变中有4例在双气囊电子小肠镜检查中发现病变;3例未能正确诊断的病例在双气囊电子小肠镜检查中均得到正确诊断.双气囊电子小肠镜在小肠狭窄中的病变检出率和诊断率均明显高于小肠钡灌检查,二者均有显著差异(P<0.05).结论:双气囊电子小肠镜对小肠狭窄有较高的病变检出率和诊断率,无严重不良反应和并发症,可作为首选检查方法.     

双气囊小肠镜对小肠出血的诊断价值

目的探讨双气囊小肠镜对小肠出血的诊断价值及安全性。方法对2007年1月-2008年12月我院经常规检查怀疑为小肠出血的56例患者行双气囊小肠镜检查,分别接受经口或经肛双气囊小肠镜检查。主要分析检查时间、内镜插入深度、确诊情况和并发症发生率。结果所有患者无严重并发症,操作时间为35-150 min,平均（76±22）min;平均插入小肠长度经口和经肛分别为（254±126）cm和（182±103）cm。小肠病变中阳性发现46例（82.1%）,主要包括血管畸形、小肠溃疡、克罗恩病、慢性非特异性炎症、肿瘤、息肉及憩室等。结论双气囊小肠镜检查安全有效,为小肠出血疾病的诊断提供了新的手段。     

胶囊内镜和双气囊小肠镜对小肠疾病诊断价值的比较

目的 分析比较胶囊内镜(CE)和双气囊小肠镜(DBE)对小肠疾病的诊断价值。方法 对2018年10月至2022年11月在我院消化内镜中心完成的164例CE和101例DBE检查患者的临床资料进行回顾性分析。比较两组患者的疾病诊断率、检查时间、检查耐受性和不良反应发生率。结果 两组患者一般资料比较差异无统计学意义(P>0.05)。DBE组的疾病检出率高于CE组(P<0.05)。DBE组疑似肠道出血患者的诊断率明显高于CE组(P<0.05),但对不明原因腹痛、腹胀及其他患者的诊断差异无统计学意义(P>0.05)。与CE组相比,DBE组需要的检查时间更短,不良反应发生率更高,检查耐受性更低(P<0.05)。结论 DBE和CE对小肠疾病的诊断都很有效,但DBE在诊断小肠出血方面表现出更大的潜力。     

A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases

AIM To compare the diagnostic yield of capsule endoscopy(CE) with that of double-balloon enteroscopy (DBE).METHODS Pubmed, Embase, Elsevier ScienceDirect,the China Academic Journals Full-text Database, and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE.Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis.RESULTS Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE [170/277 vs 156/277, OR 1.21 (95% CI 0.64-2.29)]. Based on sub analysis, the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches [137/219 vs 110/219, OR 1.67 (95% CI 1.14-2.44), P ＜ 0.01), but not superior to the yield of DBE with combination of the two insertion approaches [26/48 vs 37/48, OR 0.33 (95% CI 0.05-2.21), P ＞ 0.05)]. A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches [118/191 vs 96/191, fixed model OR 1.61(95% CI 1.07-2.43), P ＜0.05)] and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches [11/24 vs 21/24, fixed modelOR 0.12 (95% CI 0.03-0.52), P ＜ 0.01)].CONCLUSION With combination of oral and anal approaches, the yield of DBE might be at least as high as that of CE. Decisions made regarding the initial approach should depend on patient's physical status, technology availability, patient's preferences, and potential for therapeutic endoscopy.     

Examining the whole bowel,double balloon enteroscopy: Indications,diagnostic yield and complications

Double balloon enteroscopy(DBE) is an advanced type of endoscopic procedure which brings the advantage of reaching the whole small bowel using anterograde or the retrograde route. This procedure is both diagnostic and interventional for a variety of small intestinal diseases, such as vascular lesions, tumors, polyps and involvement of inflammatory bowel diseases.Main indication is the diagnosis and treatment of mid-gastrointestinal bleeding according to the recent published data all over the world. The complication rates seem to be higher than conventional procedures but growing experience is lowering them and improving the procedure to be safe and well tolerated. This review is about the technique, indications, diagnostic importance and complications of DBE according to the literature growing since 2001.     

双气囊小肠镜在小肠疾病诊断中的应用

目的评价双气囊小肠镜对小肠疾病的诊断价值。方法19例经B超、CT、胃镜、肠镜等常规检查不能明确病凼的患者,其中腹痛待查5例,腹泻待查2例,不明原因的消化道出血7例,腹痛伴有黑便2例,腹痛伴有腹泻3例,接受双气囊小肠镜检查,评价其病变检出率、并发症及患者的耐受性等。结果19例患者经口进镜2例,经肛进镜5例,接受经口＋经肌检查12例。19例患者中15例发现阳性病灶,总体病因确诊率78．9％;不明原因消化道出血病因确诊率71．4％,腹痛、腹泻的病因确诊率分别为80％和50％,2例腹痛伴有黑便者及3例腹痛伴有腹泻者均获得病因学诊断,未见操作相关的严重不良反应和并发症,结论双气囊小肠镜是一种对小肠疾病诊断价值较高、安全可靠的检查手段。     

Primary intestinal lymphangiectasia diagnosed by capsule endoscopy and double balloon enteroscopy

Primary intestinal lymphangiectasia(PIL)is a rare disorder characterized by dilated intestinal lymphatics and the development of protein-losing enteropathy.Patients with PIL develop hypoalbuminemia,hypocalcemia,lymphopenia and hypogammaglobulinemia,and present with bilateral lower limb edema,fatigue,abdominal pain and diarrhea.Endoscopy reveals diffusely elongated,circumferential and polypoid mucosae covered with whitish enlarged villi,all of which indicate intestinal lymphangiectasia.Diagnosis is conf irmed by characteristic tissue pathology,which includes dilated intestinal lymphatics with diffusely swollen mucosa and enlarged villi.The prevalence of PIL has increased since the introduction of capsule endoscopy.The etiology and prevalence of PIL remain unknown.Some studies have reported that several genes and regulatory molecules for lymphangiogenesis are related to PIL.We report the case of a patient with PIL involving the entire small bowel that was confirmed by capsule endoscopy and double-balloon enteroscopy-guided tissue pathology who carried a deletion on chromosome 4q25.The relationship between this deletion on chromosome 4 and PIL remains to be investigated.     

Double-balloon enteroscopy for mesenchymal tumors of small bowel:Nine years’ experience

AIM:To assess the value of double-balloon enteroscopy(DBE) for the diagnosis of gastrointestinal mesenchymal tumors(GIMTs) in the small bowel and clarify their clinical and endoscopic characteristics.METHODS:A retrospective review in a total of 783 patients who underwent a DBE procedure from January 2003 to December 2011 was conducted.Data from patients with pathologically confirmed GIMTs were analyzed at a single tertiary center with nine years’ experience.The primary outcomes assessed included characteristics of patients with GIMTs,indications for DBE,overall diagnostic yield of GIMTs,endoscopic morphology,positive biopsy,comparison of diagnosis with capsule endoscopy,and subsequent interventional management.RESULTS:GIMTs were identified and analyzed in 77 patients.The mean age was 47.74 ± 14.14 years(range:20-77 years),with 63.6% being males.The majority of individuals presented with gastrointestinal bleeding,accounting for 81.8%,followed by abdominal pain,accounting for 10.4%.Small bowel pathologies were found in 71 patients,the detection rate was 92.2%.The diagnostic yield of DBE for GIMTs was 88.3%.DBE was superior to capsule endoscopy in the diagnosis of GIMTs(P = 0.006;McNemar’s χ2 test).Gastrointestinal stromal tumor was the most frequent and leiomyoma was the second frequent GIMT.Single and focal lesions were typical of GIMTs,and masses with smooth or unsmooth surface were the most common in the small bowel.GIMTs were removed from all the patients surgically except one patient treated with endoscopic resection.CONCLUSION:DBE is a safe and valuable procedure for patients with suspected GIMTs,and it provides an accurate position for subsequent surgical intervention.     

胶囊内镜与单气囊小肠镜对可疑小肠疾病的诊断价值

目的比较胶囊内镜与单气囊小肠镜对小肠疾病的诊断价值。方法 2009年6月-2011年12月共有37例疑诊为小肠疾病的患者接受了胶囊内镜(CE)和单气囊小肠镜(SBE)检查。比较两种检查方法对小肠疾病的检出情况。结果在37例患者中,CE检查发现阳性病变28例,总体诊断率为75.68%(28/37),SBE检查发现阳性病变33例,总体诊断率为89.19%(33/37),两者之间差异无统计学意义(P=0.221)。CE和SBE检查结果不一致,CE检查阳性而SBE检查阴性3例,CE检查阴性而SBE检查阳性8例,CE和SBE检查均阴性1例。CE全小肠检查完成率为94.59%(35/37);SBE全小肠检查完成率为57.14%(4/7)。两种检查方法均未发生严重并发症。结论胶囊内镜和单气囊小肠镜对小肠疾病的诊断价值相当。     

Double balloon enteroscopy in the old: experience from China

AIM: To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases.METHODS: DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis.RESULTS: Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively.CONCLUSION: DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.     

Double-balloon enteroscopy in small bowel tumors: A Chinese single-center study

AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be consider