OMOM胶囊内镜检查在消化道疾病中的应用价值

目的探讨OMOM胶囊内镜在消化道疾病中的应用价值。方法对79例临床表现为不明原因消化道系统症状患者行OMOM胶囊内镜检查。结果完成小肠检查75例,检出病变46例（检出率58．2％）,其中肠道血管畸形15例,小肠黏膜糜烂、黏膜下占位性病变各4例,小肠憩室、结核、过敏性紫癜、钩虫症、蛔虫症各1例,小肠多发息肉5例;食管炎1例,胃内黏膜糜烂8例,十二指肠炎症2例,十二指肠溃疡及结肠溃疡各1例;阴性33例。患者均无不适感。结论胶囊内镜对小肠疾病（尤其是不明原因消化道出血）具有较高诊断价值,对胃和结肠疾病也有一定诊断价值。     

国产与进口胶囊内镜796例临床应用分析

目的探讨国产胶囊内镜与进口胶囊内镜对小肠疾病的诊断价值及安全性。方法选择2003～2018年我院行了胶囊内镜检查患者796例,根据胶囊内镜的不同分为两组。A组414例患者采用以色列M2A胶囊内镜检查,病因包括不明原因消化道出血194例,不明原因慢性腹泻87例,不明原因腹痛90例,不明原因贫血43例;B组382例患者采用国产OMOM胶囊内镜,包括不明原因消化道出血173例,不明原因慢性腹泻97例,不明原因腹痛85例,不明原因贫血27例。结果 A组共411例完成检查,B组共381例完成检查,检查总成功率为99.50%(792/796)。A组全小肠检查成功率为86.71%(359/414);B组全小肠检查成功率为95.03%(363/382)。A组不明原因消化道出血患者病变检出率为80.41%(156/194),不明原因腹泻患者病变检出率为68.97%(60/87),不明原因腹痛患者病变检出率为63.33%(57/90),不明原因贫血患者病变检出率为55.81%(24/43)。B组不明原因消化道出血患者病变检出率为85.55%(148/173),不明原因腹泻患者病变检出率为61.86%(60/97),不明原因腹痛患者病变检出率为60.00%(51/85),不明原因贫血患者病变检出率为55.56%(15/27)。A组病变检出率为71.74%(297/414),B组病变检出率为71.73%(274/382),两组检出率差异无统计学意义(P 0.05)。结论胶囊内镜对小肠疾病有较高诊断价值,国产OMOM胶囊内镜的检出率与诊断率与M2A胶囊内镜相当。     

胶囊内镜在不同小肠疾病诊断中的应用价值

目的探讨胶囊内镜在不同小肠疾病诊断中的应用价值。方法 42例患者进行胶囊内镜检查,其中不明原因消化道出血25例、慢性腹痛6例、慢性腹泻7例、慢性腹痛伴腹泻3例、体检1例,观察运行时间及病变检出率。结果 42例患者中33例(78.57%)通过回盲瓣,2例胶囊内镜滞留于胃内。胶囊内镜胃内平均停留时间为77.5 m in,经过小肠平均时间为286.5 m in。病变总检出率为76.19%,其中不明原因消化道出血88%、慢性腹痛83.3%、慢性腹泻42.8%、慢性腹痛伴腹泻66.7%。不明原因消化道出血的病变检出率明显高于慢性腹泻(P0.05)。检查过程中患者无不适及并发症。结论胶囊内镜对小肠病变的检出率较高,且安全、方便,可作为小肠疾病的首选检查方法,尤其可作为不明原因消化道出血患者的常规检查。     

胶囊内镜在消化道疾病诊断中的应用

目的了解胶囊内镜在消化道疾病，特别是对小肠疾病中的临床诊断应用价值。方法2004年2月至2006年2月间，应用GIVEN公司产M2A胶囊内镜检查74例，其中53例患者（分为不明原因消化道出血30例，反复发作腹痛、腹泻患者23例）经过胃镜和结肠镜检查，41例未发现可解释疾病的阳性结果，12例有胃黏膜的慢性炎症、息肉或结肠息肉；21例为健康体检者。结果0例不明原因出血的患者中，小肠病变诊断的阳性率为76．7％（23／30），其中小肠克罗恩病5例，小肠血管畸型6例，小肠黏膜糜烂11例和小肠息肉样隆起5例，其中3例经过手术证实为小肠肿瘤，1例为罕见的Cronkhite-Canada综合征，另有小肠憩室1例；持续腹痛、腹泻组的23例患者中，小肠病变诊断的阳性率为65．2％（15／23），其中小肠黏膜糜烂8例、回肠末端多发小溃疡7例，小肠多发息肉5例；21例健康查体者中有1例可见小肠多发细小的息肉样隆起，2例为小肠黏膜的炎症，8例为胃黏膜炎症，其余10例未见任何异常。疑诊小肠疾病的53例患者小肠病变的诊断阳性率为71．7％（38／53），胶囊内镜对出血组患者小肠黏膜病变诊断阳性率高于腹痛组，但差异无统计学意义；出血组患者胶囊在胃排空时间、小肠通过时间和排出体外时间均明显少于查体组。结论胶囊内镜对小肠疾病的诊断阳性率高，而且安全无痛苦，具有较好的临床应用价值，尤其适用于不明原因的消化道出血患者。     

影响胶囊内镜诊断不明原因消化道出血因素的分析

目的为提高胶囊内镜诊断不明原因消化道出血的诊断率,探讨影响胶囊内镜诊断不明原因消化道诊断率的因素。方法胶囊内镜检查172例,其中不明原因的消化道出血的患者61例,分为2组,A组为胶囊内镜检查明确出血病变者,B组为无明确出血病变者,根据年龄、性别、病史、病变程度、病变表现、排空时间、肠道清洁、检出率、诊断率等对比分析。结果消化道出血的检出率为88．52％,包括胃炎、肠炎、血管畸形、肠息肉、食管静脉曲张等。出血的诊断率为67．2％,包括小肠糜烂,克罗恩病、糜烂性胃炎、溃疡病、肿瘤等。两组病人年龄、性别比较无明显差异,A组病史活动性出血者多,病史长,合并症多,小肠转运时间较长,肠道清洁好,病变程度重,病变检出率高。结论注意病人的选择、合理的小肠转运时间、肠道清洁好、了解出血原因和排序、提高病变鉴别、图像解读及临床综合判断和随访等,可以提高胶囊内镜检查的诊断率,使不明原因消化道出血病变得到及时明确的处理。     

胶囊内镜与双气囊内镜诊断小肠疾病的比较

目的比较胶囊内镜和双气囊内镜对小肠疾病的检出率和诊断准确性，探讨其联合应用的临床意义。方法对116例不明原因消化道出血和102例不明原因腹痛或腹泻患者，共218例进行内镜检查。其中165例首选胶囊内镜，53例首选双气囊内镜。对胶囊内镜检查阴性或可疑病变者建议双气囊内镜检查，反之亦然。比较两种检查方法对小肠疾病的检出率、诊断率以及患者依从性、不良反应发生率等。结果1例胶囊内镜和2例双气囊内镜操作失败。51例患者行64次双气囊内镜检查，其中34例经口、4例经肛检查，13例分别接受经口和经肛检查。胶囊内镜对小肠病变的总检出率及对不明原因消化道出血的小肠疾病检出率（72．0％和88．0％），均明显高于双气囊内镜（41．2％和60．0％），诊断率也高于后者（51．8％和39．2％）。5例胶囊内镜检查阴性再经双气囊内镜检查者中，1例发现病灶；15例胶囊内镜检查怀疑小肠病变者中，12例经双气囊内镜结合活检病理确诊。而3例双气囊内镜未发现异常者再经胶囊内镜检查发现小肠病变。所有患者均未发生严重不良反应。结论胶囊内镜对小肠疾病检出率高，可作为怀疑小肠疾病，尤其是不明原因消化道出血的首选检查方法；双气囊内镜在胶囊内镜检查阴性者中仍可发现部分病灶，并能明确多数胶囊内镜下可疑病变，可作为胶囊内镜检查后的补充检测手段。     

胶囊内镜在消化道疾病中的应用

目的探讨胶囊内镜对消化道疾病的诊断价值。方法对45例消化道疾病患者及健康查体者行胶囊内镜检查。结果胶囊内镜显示病变38例（84．4％）,其中小肠血管畸形18例,克罗恩病3例,小肠良性狭窄1例,增生性病变1例,胃肠息肉6例,末端回肠炎2例,小肠肿瘤2例,十二指肠溃疡3例,胆汁反流性胃炎2例;7例无阳性发现。检查过程中患者无不适及并发症。结论胶囊内镜对胃及小肠病变检出率高,可作为不明原因消化道出血或长期腹泻、腹痛患者的常规检查。     

胶囊内镜与推进式小肠镜诊断不明原因消化道出血的评价

目的 比较胶囊内镜与推进式小肠镜对不明原因消化道出血的诊断价值。方法 总结32例消化道出血患者的胶囊内镜检查结果及36例消化道出血患者推进式小肠镜检查结果，上述患者均经结肠镜、胃镜、X线钡餐、小肠钡剂灌肠、血管造影或核素扫描等检查未发现异常。结果 胶囊内镜检查的32例中共发现异常26例，检出率为8l％。其中能明确解释出血原因者2l例，包括消化道血管病变8例，小肠炎症性肠病5例，小肠息肉4例，小肠恶性间质肿瘤2例，小肠类癌l例(该患者同时伴升结肠脂肪瘤)及出血性胃炎l例；疑诊5例。推进式小肠镜检查的36例明确出血原因9例，即诊断率为25％，包括空肠上段血管畸形2例，平滑肌肉瘤2例，平滑肌瘤、腺瘤性息肉、克罗恩病、壶腹部腺癌及淋巴瘤各l例；疑诊2例。结论 胶囊内镜对不明原因消化道出血具有较高的检出率和诊断率，检查效果及方法明显优于推进式小肠镜。胶囊内镜可明显简化不明原因消化道出血患者的检查步骤．应成为经胃镜、结肠镜检查阴性患者的首选检查方法。     

胶囊内镜诊断不明原因小肠出血15例临床观察

小肠不明原因出血是一个反复发作、慢性的过程。传统的检查方法主要是胃结肠镜检查,由于其无法到达小肠,不能发现小肠部位的病变,阳性检出率较低。随着胶囊内镜的推广使用,小肠部位阳性病变检出率明显提高。2010年4月～2011年7月,我院对15例小肠不明原因出血的患者采用胶囊内镜检查。现报告如下。     

不明原因腹痛患者胶囊内镜检查的应用分析

目的探讨胶囊内镜在诊断不明原因腹痛的临床价值及安全性。方法将本院73例不明原因腹痛患者进行胶囊内镜检查,对检查结果进行分析。结果 73例患者中50例被检出小肠病变,检出率为68.49%。其中小肠克罗恩病6例、回肠多发性溃疡2例、小肠多发性毛细血管扩张1例、小肠息肉4例、小肠肿瘤1例、小肠寄生虫2例、小肠黏膜糜烂22例。12例分别为慢性浅表性胃炎、结肠炎、十二指肠溃疡。23例检查无异常。结论胶囊内镜操作简单、安全性高,对不明原因腹痛有较高的诊断价值。     

胶囊内镜在小肠疾病诊断中的作用

目的:小肠疾病很难诊断,现有的诊断技术又不尽如人意,而胶囊内镜能发现整个小肠内的微小病变。为此,我们对胶囊内镜在小肠疾病诊断中的价值进行评估。方法:自2002年5月至2003年9月,我们对经结肠镜、胃镜、X线钡餐造影、小肠钡灌造影、血管造影或核素扫描等检查未发现异常的79例疑患小肠疾病、尤其是不明原因消化道出血的患者,进行胶囊内镜检查,其中不明原因的消化道出血患者56例。结果:75例完成最终研究。75例患者中经胶囊内镜检查共发现异常63例,检出率为84％;其中能明确解释临床病因者50例,诊断率为66.6％,包括消化道血管病变21例、小肠炎症性肠病16例、小肠息肉5例、小肠恶性间质肿瘤2例、小肠类癌1例(该患者同时伴升结肠脂肪瘤)、淋巴瘤1例、粘膜下肿瘤3例及憩室1例。所获取的图像质量良好。结论:胶囊内镜对小肠疾病尤其是不明原因消化道出血具有良好的诊断价值。     

Economic aspects and evidence-based decision making in evaluating patients with suspected small bowel disorders

Obscure gastrointestinal hemorrhage is defined as overt or occult bleeding present after normal endoscopic examination of the upper and lower gastrointestinal tracts. Approximately 5% of patients with gastrointestinal hemorrhage can be classified as having obscure bleeding, with most patients found to have responsible lesions in the small intestine. The advent of video capsule endoscopy and deep enteroscopy allows for endoscopic access and therapeutic options in the small intestine. In our current era of cost minimization, reductions in capital equipment expenditures, and a high rate of malpractice claims against clinicians, the decision regarding whether a clinical enterprise should offer small bowel endoscopy using any of the more recent technologies requires an understanding of several factors. This article highlights some of the economic and medicolegal aspects of deep small bowel endoscopy. The following topics will be discussed: costs involved to perform endoscopic imaging of the small bowel; downstream revenue effect resulting from deep enteroscopy; coding, billing, and reimbursement issues; cost-effectiveness studies for diagnostic testing; algorithms for diagnostic evaluation of patients with suspected small bowel pathology; and medicolegal ramifications associated with endoscopic procedures of the small bowel.     

Wireless capsule endoscopy for diagnosis of small intestinal lesions

Background: Capsule endoscopy represents a new and highly innovative method of visualizing the small intestine. The aim of the present study was to evaluate the practicality, usefulness and diagnostic yield of capsule endoscopy in a group of patients with suspected small intestinal disease. Methods: Eleven patients underwent capsule endoscopy using the M2A Capsule Endoscope? (Given Imaging, Yogneam, Israel). The indications for the procedure were: obscure gastrointestinal (GI) bleeding in seven patients, evaluation of Crohn's disease in three patients and unexplained abdominal pain and weight loss in one patient. Results: Abnormalities were detected in six of 11 patients overall. Detection of abnormalities was highest among patients with obscure GI bleeding where active bleeding and/or the source of bleeding was identified in five of the seven (71.4%) patients. One of the three patients with Crohn's disease had an ileal ulcer detected, while the remaining patient with unexplained weight loss and pain had a normal examination. Conclusion: We have found in our preliminary experience that capsule endoscopy is a useful and practical procedure to perform especially for evaluation of obscure GI bleeding.     

Frequency of small bowel polyps in patients with duodenal adenoma but without familial adenomatous polyposis

INTRODUCTION: It is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis (FAP) are at greater risk for small bowel neoplasia. We therefore conducted a study to determine the frequency of small bowel polyps in patients with non-papillary duodenal adenomas using capsule endoscopy for small bowel examination. PATIENTS AND METHODS: 14 patients (8 women, 6 men; mean age 67 +/- 10 years; range: 49 - 77 years) with non-papillary duodenal adenomas without FAP were included. All patients underwent wireless capsule endoscopy. The results were compared with an age- and sex-matched cohort of patients undergoing capsule endoscopy for suspected small bowel disease. RESULTS: Overall, 15 polyps ranging between 1 and 8 mm in diameter were detected in eight patients of the study group, whereas no polyps could be identified in the control group. Natural excretion of the capsule within 24 hours was always reported and no complications were reported by any of the patients. Other pathological findings were multiple angiodysplasias in two patients of the study group. In the control group capsule endoscopy detected angiodysplasias in 5 patients with the indication obscure gastrointestinal bleeding, and inflammatory lesions in 2 patients with suspected Crohn's disease. CONCLUSIONS: Based on the results of this prospective study, the frequency of small bowel polyps in patients with duodenal adenomas without familial adenomatous polyposis appears to be increased compared with a control group undergoing capsule endoscopy for other reasons. In none of the patients was the management altered. Follow-up data of these patients will be needed.     

Wireless capsule endoscopy for obscure small-bowel disorders: final results of the first pediatric controlled trial.

BACKGROUND AND AIMS: Obscure small-bowel disorders are jejunal and ileal lesions undiagnosed by traditional imaging techniques (endoscopic, radiologic). We evaluated the diagnostic usefulness and safety of capsule endoscopy for obscure small-bowel disorders in children and adolescents. METHODS: Comparative, prospective, self-controlled trials in patients (age, 10-18 y) suspected to have either small-bowel Crohn's disease, polyps, or obscure gastrointestinal (GI) bleeding. Capsule results were compared with the diagnostic imaging studies normally used in this age group. RESULTS: Among 20 patients suspected of Crohn's disease, multiple lesions consistent with this diagnosis were observed by capsule endoscopy in 50%. Small-bowel Crohn's disease was ruled out in 8 patients. Eosinophilic enteropathy was found in 2 others. For polyp detection (n = 6), capsule endoscopy yielded 100% concordance with the control studies when analyzed per patient. However, capsule endoscopy revealed a greater number (50%) of polyps. Among patients with obscure bleeding (n = 4), the capsule examination confirmed a diagnosis of vascular malformations in 3. Capsule endoscopy more accurately identified the precise source of bleeding compared with angiography. All 30 capsule studies were well tolerated, although 1 capsule was retained owing to an inflammatory stenosis. The capsule eventually was expelled after corticosteroid therapy. CONCLUSIONS: Capsule endoscopy correctly diagnosed or excluded a bleeding source, small-bowel polyps, or Crohn's disease of the small bowel in 29 of 30 patients. Capsule endoscopy permits an accurate, noninvasive approach for diagnosing obscure small bowel lesions in children over the age of 10.     

Capsule endoscopy in 2005: facts and perspectives

Capsule endoscopy has recently been introduced to explore endoscopically the whole small intestine, fulfilling a gap between examinations of the upper and lower gastrointestinal tract. The technique consists of a miniaturized endoscope, embedded in a swallowable capsule that is propulsed by peristalsis and achieves the journey to the right colon in five to eight hours. Images captured by the capsule are recorded on a hard drive worn in a belt by the patient. The main indication for capsule examination is the examination of the small bowel to find a bleeding lesion in patients with obscure bleeding. Several studies have shown that the diagnostic yield of capsule endoscopy is superior to that of push enteroscopy in this indication. Other possible indications are patients with suspected intestinal location of Crohn's disease, familial adenomatous polyposis, complicated coeliac disease and lesions due NSAIDs. The review contains information on the technical aspects of capsule endoscopy and discusses the indications. Issues of safety and tolerance are also discussed.     

Clinical utility, safety and tolerability of capsule endoscopy in urban Southeast Asian population

AIM: Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies. In this prospective study, we aimed to determine the clinical utility, safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population.METHODS: We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel pathology. In 9 patients the indication was obscure gastrointestinal bleeding, while in 6 patients it was to determine the extent of small bowel involvement in Crohn‘s disease. One patient underwent capsule endoscopy for evaluation of chronic abdominal pain. Patient‘‘s tolerabilityto the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events.RESULTS: Abnormal findings were present in 8 patients (50 %). The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 patients. Findings included 2 cases of angiodysplasia, 2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal ulcer. One patient had smallbowel erosions and foci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn‘‘s disease. Capsule endoscopy was well tolerated by allpatients. One patient with Crohn‘‘s disease had a complication of capsule retention due to terminal ileum stricture. Thecapsule eventually passed out spontaneously after 1 month. CONCLUSION: Our study, which represented the first Asian series, further confirms the diagnostic utility, safety and tolerability of wireless capsule endoscopy.     

胶囊内镜的临床应用

目的 小肠疾病很难诊断，现有的诊断技术又不尽如人意，而胶囊内镜（M2A）能发现整个小肠内的微小病变，且为非侵入性，患者无需住院，因此，对胶囊内镜在小肠疾病诊断中的价值。依从性和安全性进行评估。方法 自2002年5月至9月，我们对经结肠镜，胃镜，X线钡餐造影，小肠钡灌造影，血管造影或核素扫描等检查未发现异常的15例疑患小肠疾病的患者，进行胶囊内镜检查，其中不明原因的消化道出血12例。结果 15例中发现病灶11例（73.3%)，包括血管发育不良，Dieulafoy病，毛细血管扩张征，静脉扩张，息肉样病变，黏膜下肿瘤，脂肪瘤，口疮样小溃疡（Aphthous ulcer)，克罗恩病类癌及出血性胃炎等，其中4例患者同时存在2种病灶，所获取的图像质量良好，胶囊停留于胃内的平均时间为82min(6-311min)，小肠内平均运行时间为248min(104-396min)，平均到达盲肠时间为336min(180-470min)，平均记录时间为449min(300-510min)，医师对胶囊内镜所传输图像的平均读片时间为82min(30-120min)，平均获取照片数为57919张，胶囊平均排出体外时间为33h(24-48h)，整个操作过程患者耐受性甚佳，无任何痛苦，吞咽胶囊无任何困难，检测过程中无任何并发症发生。结论 胶囊内镜是对小肠疾病具有诊断价值的医疗设备，其安全性高，依从性好。     

Wireless capsule endoscopy for pediatric small-bowel diseases

OBJECTIVE: Although capsule endoscopy (CE) is becoming an increasingly popular procedure, only recently data on its clinical application in pediatric gastroenterology are just emerging. Our aim is to investigate the diagnostic value of CE in small intestine diseases and to determine its safety, tolerance, and applicability in a large number of pediatric patients referred to our Tertiary Center of Pediatric Gastroenterology Unit, University of Parma. METHODS: A total of 87 Italian patients, 49 of which were male with an age range from 18 months to 18 yr with a suspected small-bowel disease (inflammatory bowel disease 37%, polyps 38%, obscure gastrointestinal bleeding 24%, malabsorption 1%), were investigated with the M2A capsule (GIVEN((R)) Imaging Ltd., Yoqneam, Israel). RESULTS: A total of 77 patients swallowed the capsule, while in 10 it was endoscopically positioned (age range 1.5-11 yr, median age 5.3 yr). Eighty patients naturally evacuated the capsule, one patient needed surgery. The capsule evidenced pathological findings in 62 patients (71%), ileal lymphoid nodular hyperplasia in four subjects (5%), it was negative in 18 subjects (21%), and technically failed in three subjects (3%). In 21 out of 28 patients with known polyposis and in all the five patients with suspected polyposis, small-bowel polyps were found. In 16 out of 22 patients suffering from known inflammatory bowel disease (Crohn's disease colitis or indeterminate colitis), small intestine lesions were found. CE examination identified a possible small intestine bleeding source in 13 out of 21 patients with suspected obscure gastrointestinal bleeding. In 5 out of 10 patients with suspected small-bowel inflammatory disease, CE evidenced ileum lesions suggesting Crohn's disease, which was subsequently confirmed through diagnostic procedures and the clinical history. A patient with malabsorption presented a negative capsule study. CONCLUSIONS: Our experience, which includes the largest number of pediatric patients and the youngest child reported in literature, confirms that CE is a very useful system for the clinical work in suspected small-bowel diseases in infancy. The high rate of positive examination is due to the very careful selection of the patients, obligatory to conduct a safe examination since CE is not highly tested in children.