胶囊内镜在老年人不明原因消化道出血中的应用价值

目的 通过分析老年不明原因消化道出血(PGIB)患者的临床资料和胶囊内镜检查结果,探讨胶囊内镜在老年OGIB患者中的应用价值. 方法 分析比较2002年5月至2007年2月,因OGIB在我院行胶囊内镜检查的老年患者及非老年患者的一般资料、出血类型及检查结果.老年组97例,男性40例、女性57例,平均年龄(70.8±6.8)岁;非老年组99例,男性61例、女性38例,平均年龄(44.4±10.3)岁. 结果 老年组显性出血89例,隐性出血8例;非老年组分别为91例和8例.两组胃排空时间、全小肠检查完成率及胶囊延迟率,差异均无统计学意义,老年组小肠转运时间较非老年组显著延长(P<0.05).老年组2例因胶囊内镜滞留于食管未纳入诊断统计,老年组获阳性诊断62例(65.3%),血管病变为最常见病因;非老年组获阳性诊断67例(67.7%).小肠克罗恩病为最常见病因.两组获得阳性诊断率差异无统计学意义,阳性诊断构成比差异有统计学意义(P<0.01).老年组未发现并发症. 结论 胶囊内镜检查对老年OGIB患者是一项安全有效的检查手段,血管病变为老年OGIB患者最常见的病因.     

胶囊内镜在老年人中消化道出血中的应用

中消化道出血即传统意义上的不明原因消化道出血(OGIB),定义为经常规上、下消化道内镜检查未能明确原因的持续或反复发作的出血或缺铁性贫血(大便隐血阳性).该病的检查手段主要有胶囊内镜、双气囊小肠镜、小肠CT、小肠气钡造影、核素扫描等.目前关于胶囊内镜在老年人OGIB患者中的应用报道尚少.本研究分析老年OGIB患者的临床资料,探讨胶囊内镜在老年OGIB患者中的应用价值.     

胶囊内镜对不明原因消化道出血诊断价值的评估

背景：对于不明原因消化道出血（OGIB），胶囊内镜是一种有价值的诊断方法。但迄今为止，该技术在OGIB诊断中应用的研究多限于小样本病例。目的：评价胶囊内镜对OGIB的诊断价值，确定其敏感性，特异性，阳性，阴性预测值和总诊断率。方法：2002年5月-2005年1月，对连续选取的91例OGIB患者行胶囊内镜检查94次，对胶囊排出时间，再检查，治疗，再出血，依从性和并发症等情况进行随访观察。结果：胶囊内镜检查的阳性率为74.7%，疑诊率为11.0%，阴性率为14.3%。其诊断OGIB的敏感性，特异性以及阳性，阴性预测值分别为94.6%、88.9%和80.0%，总诊断率为93.8%。检查过程中仅1例（1.1%）患者发生胶囊滞留，后经手术取出并证实为克罗恩病所致的肠腔狭窄。结论：胶囊内镜对于OGIB是一种有效而安全的检查手段，迟早行胶囊内镜检查可使患者早日明确诊断并得到及时治疗，从而改善预后。     

胶囊内镜在不明原因消化道出血患者诊断中的应用价值

不明原因消化道出血（obscure gastrointestinal bleeding,OGIB）是指结肠镜和上消化道内镜未发现明确病因的持续或反复发作的消化道出血,在消化道出血中约占5％。由于OGIB的出血部位多位于小肠,常规内镜和传统检查方法对其诊断价值有限。而诊断率较高的双气囊小肠镜,不仅操作费时、患者耐受性差、并发症多,而且全小肠检查成功率也仅62．5％。胶囊内镜作为一种无创的小肠检查方式,患者无痛苦,亦无明显不良反应和并发症。本研究通过分析我院OGIB患者的胶囊内镜检查及随访结果,探讨其在OGIB诊断中的价值。     

胶囊内镜在不明原因消化道出血诊断中的应用

背景：胶囊内镜是明确不明原因消化道出血（OGIB）的检查手段之一,其诊断率可能受到检查时机和出血自然病程的影响。目的：探讨胶囊内镜在OGIB诊断中的应用价值和最佳检查时机。方法：收集2010年10月～2012年6月厦门大学附属中山医院46例接受胶囊内镜检查的OGIB患者。回顾性分析胶囊内镜检查诊断OGIB的阳性率、疑诊率、敏感性、特异性、阳性预测值和阴性预测值,比较不同检查时机对OGIB检出率的影响。结果：胶囊内镜检查诊断OGIB的阳性率为71．7％,疑诊率为13．0％,阴性率为15．2％,诊断敏感性、特异性以及阳性预测值、阴性预测值分别为96．3％、75．0％、92．9％、85．7％。活动性出血组的检出率显著高于出血停止组（96．3％对68．4％,P=0．030）,显性出血者的检出率与隐性出血者相比差异无统计学意义（100％对75．0％,P=0．148）。出血停止≤2周者的检出率显著高于出血停止〉2周者（90．9％对37．5％,P=0．041）。结论：胶囊内镜是诊断OGIB的一种安全、有效的检查手段,出血后尽早行胶囊内镜检查可能提高阳性诊断率并为进一步干预创造条件。     

胶囊内镜对不明原因消化道出血的诊断价值

目的 比较胶囊内镜与传统小肠俭查方法对不明原因消化道出血的诊断价值。方法 总结分析67例胃镜、肠镜检查阴性的消化道出血患者中消化道钡餐、肠系膜动脉造影、推进式小肠镜、胶囊内镜及剖腹探查包括手术中肠镜结果。结果 不明原因消化道出血上、中消化道钡餐检查检出率为17．6％，诊断率为13．8％；肠系膜动脉造影检查检出率和诊断率均为13．4％；推进式小肠镜检查检出率、诊断率为．32％；剖腹探查及术中肠镜检出率和诊断率均为83．3％；胶囊内镜检查检出率为80．6％，诊断率为67．7％结论 胶囊内镜检查对于不明原因消化道出血具有较高的检出率和诊断率．明显优于传统的检查方法。     

胶囊内镜与多排螺旋CT在诊断不明原因消化道出血中的临床价值

目的探讨胶囊内镜（capsule endoscopy,CE）与多排螺旋CT（mutiple-detector computertomography,MDCT）在不明原因消化道出血中的诊断价值。方法应用CE和MDCT对60例不明原因消化道出血患者进行比较研究,并与手术病理结果对照。结果CE的诊断阳性率为60．0％（36／60）,MDCT的诊断阳性率为38．3％（23／60）,P〈0．01。CE和MDCT联合诊断的阳性率为66．7％（40／60）,与单纯CE相比P〉0．05,与单纯MDCT相比P〈0．01。诊断的主要病变有间质瘤、血管瘤、克罗恩病、血管畸形、Meckel憩室、钩虫病等。在手术确诊病例中,两者的诊断阳性率差异无统计学意义。结论对不明原因消化道出血,CE的诊断阳性率高于MDCT,联合检查并未提高诊断阳性率,但综合考虑CE和MDCT检查的优缺点,认为MDCT检查在小肠肿瘤的病变性质及肠外情况全面了解中具有优势,建议对不明原因消化道出血进行CE和MDCT的联合检查。     

胶囊内镜在不明原因消化道出血中的临床应用

目的探讨胶囊内镜在不明原因消化道出血中的诊断价值、耐受性、并发症。方法对20例不明原因消化道出血患者行OMOM胶囊内镜检查。结果15例胶囊内镜下发现异常,12例明确为出血病灶,诊断率为60%（12/20）,包括克罗恩病5例,间质瘤4例,晚期肿瘤1例,新鲜出血1例,血管瘤1例。20例受检者均耐受良好,2例出现了胶囊滞留。结论胶囊内镜对不明原因消化道出血有较高的诊断率,易耐受,胶囊滞留是其主要并发症,易发生于克罗恩病患者。     

胶囊内镜诊断不明原因消化道出血临床研究

胶囊内镜对小肠病变的诊断价值已得到肯定，尤其是对不明原因消化道出血的诊断，有其他传统方法不可替代的优势。我们在3年间进行该类检查56例，报道如下。     

胶囊内镜诊断不明原因消化道出血的价值

背景：不明原因消化道出血（OGIB）的诊断是临床难题之一。随着内镜技术的革新,OGIB的诊治水平不断提高。目的：评价胶囊内镜诊断OGIB的价值。方法：回颐性分析南京鼓楼医院2003年5月～2008年4月行胶囊内镜检查的OGIB患者的资料。结果：胶囊内镜的OGIB总检出率为82．6％（228／276）。小肠病变检出率为77．5％（214／276）,其中以血管动静脉畸形（AVM）最为常见,其次为小肠占位和小肠克罗恩病（CD）。14例（5．1％）患者的出血部位位于小肠以外,其中5例位于胃内,9例为结肠病变。所有患者均未出现肠梗阻症状。与〈50岁的患者相比。≥50岁者的小肠AVM检出率显著增高（33．9％对19．6％,P=0．016）,小肠占位和寄生虫病检出率均无明显差异。男性患者的小肠CD检出率显著高于女性患者（17．1％对6．8％,P=0．018）。结论：胶囊内镜检查安全、无创伤,诊断OGIB的价值较高。OGIB以小肠AVM最为多见,其次为小肠占位和CD。     

Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding

AIM: To assess whether video capsule endoscopy(VCE) affects the outcomes of left ventricular assist devices(LVADs) recipients with gastrointestinal bleeding.METHODS: This is a retrospective study of LVAD recipients with obscure gastrointestinal bleeding(OGIB) who underwent VCE at a tertiary medical center between 2005 and 2013. All patients were admitted and monitored with telemetry and all VCE and subsequent endoscopic procedures were performed as inpatients. A VCE study was considered positive only when P2 lesions were found and was regarded as negative if P1 or P0 were identified. All patients were followed until heart transplant, death, or the end of the study.RESULTS: Between 2005 and 2013, 30 patients with LVAD underwent VCE. Completion rate of VCE was 93.3% and there was no capsule retention. No interference of VCE recording or the function of LVAD was found. VCE was positive in 40% of patients(n = 12). The most common finding was active small intestinal bleeding(50%) and small intestinal angiodysplasia(33.3%). There was no difference in the rate of recurrent bleeding between patients with positive and negative VCE study(50.0% vs 55.6%,P = 1.00) during an average of 11.6 ± 9.6 mo follow up. Among patients with positive VCE, the recurrent bleeding rate did not differ whether subsequent endoscopy was performed(50% vs 50%, P = 1.00).CONCLUSION: VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.     

Re-bleeding events in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

AIM: To investigate long-term re-bleeding events after a negative capsule endoscopy in patients with obscure gastrointestinal bleeding(OGIB) and the risk factors associated with the procedure.METHODS: Patients referred to Hospital Egas Moniz(Lisboa, Portugal) between January 2006 and October 2012 with OGIB and a negative capsule endoscopy were retrospectively analyzed. The following study variables were included: demographic data, comorbidities, bleeding-related drug use, hemoglobin level, indication for capsule endoscopy, post procedure details, work-up and follow-up. Re-bleeding rates and associated factors were assessed using a Cox proportional hazard analysis. The Kaplan-Meier method was used to estimate the cumulative incidence of re-bleeding at 1, 3 and 5 years, and the differences between factors were evaluated.RESULTS: The study population consisted of 640 patients referred for OGIB investigation. Wireless capsule endoscopy was deemed negative in 113 patients(17.7%). A total of 64.6% of the population was female, and the median age was 69 years. The median follow-up was forty-eight months(interquartile range 24-60). Re-bleeding occurred in 27.4% of the cases. The median time to re-bleeding was fifteen months(interquartile range 2-33). In 22.6%(n = 7) of the population, small-bowel angiodysplasia was identified as the culprit lesion. A univariate analysis showed that age > 65 years old, chronic kidney disease, aortic stenosis, anticoagulant use and overt OGIB were risk factors for re-bleeding; however, on a multivariate analysis, there were no risk factors for re-bleeding. The cumulative risk of re-bleeding at 1, 3 and 5 years of follow-up was 12.9%, 25.6% and 31.5%, respectively.Patients who presented with overt OGIB tended to rebleed sooner(median time for re-bleeding: 8.5 mo vs 22 mo).CONCLUSION: Patients with OGIB despite a negative capsule endoscopy have a significant re-bleeding risk; therefore, these patients require an extended follow-up strategy.     

Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

AIM:To investigate long-term outcome in obscure gastrointestinal bleeding(OGIB) after negative capsule endoscopy(CE) and identify risk factors for rebleeding.METHODS:A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital.Ninety-five patients(84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study.Follow-up data were obtained from the patients’ medical records.The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases.The primary outcome measure was the detection of rebleeding after CE,and factors associated with rebleeding were evaluated using multivariate analysis.RESULTS:Of the 95 enrolled patients(median age 61 years,range 17-85 years),62 patients(65.3%) were male.The median duration of follow-up was 23.7 mo(range 6.0-89.4 mo).Seventy-three patients(76.8%) underwent CE for obscure-overt bleeding.Complete examination of the small bowel was achieved in 77 cases(81.1%).Significant lesions were found in 38 patients(40.0%).The overall rebleeding rate was 28.4%.The rebleeding rate was higher in patients with positive CE(36.8%) than in those with negative CE(22.8%).However,there was no significant difference in cumulative rebleeding rates between the two groups(log rank test;P = 0.205).Anticoagulation after CE examination was an independent risk factor for rebleeding(hazard ratio,5.019;95%CI,1.560-16.145;P = 0.007),regardless of CE results.CONCLUSION:Patients with OGIB and negative CE have a potential risk of rebleeding.Therefore,close observation is required and alternative modalities should be considered in suspicious cases.     

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。     

Time to endoscopy and outcomes in upper gastrointestinal bleeding

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB.

METHODS

Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements.

RESULTS

From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h.

CONCLUSIONS

Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.     

Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

AIM:To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS:We identified patients who underwent CE at our institution from August 2003 to December 2009.Patient medical records were reviewed to determine type of OGIB (occult,overt),CE results and complications,and timing of CE with respect to onset of bleeding.RESULTS:Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by CE.In 222 patients (...     

不同年龄层不明原因消化道出血患者胶囊内镜诊断结果分析

目的 对不明原因消化道出血患者的胶囊内镜(CE)检查结果进行分析,总结不同年龄层患者的病变特点.方法 收集我院2006年12月～2010年2月间符合纳入标准的患者163例,采集患者信息并分析病变特点.结果 163例患者中,老年组患者检出率高于青年组和中年组,差异有统计学意义(P＜0.01);不同年龄组患者检出病变类型分布比较,差异有统计学意义(P＜0.05),青年组以肿物为主;中年组以溃疡、血管畸形为主;老年组以血管畸形为主.结论 各年龄组间的检出率和诊断率比较差异有统计学意义(P＜0.05),提示CE检查对老年组患者的不明原因消化道出血有更好的检出率.