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，进行胶囊内镜检查，其中不明原因的消化道出血患56例。结果：75例完成最终研究。75例患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。     

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。     

双气囊内镜和胶囊内镜诊断小肠出血的临床评价

目的评价双气囊内镜和胶囊内镜对小肠出血的临床诊断价值。方法比较双气囊内镜、胶囊内镜及全消化道造影对小肠出血病灶的总体检出率;通过自身对照,比较双气囊内镜和胶囊内镜对小肠出血诊断率;分析胶囊内镜对1次双气囊内镜检查明确诊断率的影响。结果105例小肠出血患者中,双气囊内镜检出克罗恩病24例,腺癌15例,慢性非特异性炎症12例,不明原因小肠溃疡10例,小肠间质肿瘤8例,小肠息肉8例,小肠血管畸形出血6例,钩虫病5例,麦克尔憩室及多发憩室5例,小肠淋巴瘤3例,无明显异常9例,阳性率91．4％（96／105）。其中40例进行胶囊内镜检查,病变检出率75．0％（30／40）;75例患者全消化道造影检查,病变检出率33．3％（25／75）。根据胶囊内镜结果1次双气囊内镜检查明确诊断率90．0％（36／40）,而根据临床特征及消化道造影结果1次双气囊内镜检查明确诊断率69．2％（45／65）。结论小肠疾病的主要病因是小肠良性溃疡（包括克罗恩病）、肿瘤、慢性炎症,其次是息肉、血管畸形、寄生虫感染、麦克尔憩室及淋巴瘤等。双气囊内镜对小肠出血诊断率高于胶囊内镜,胶囊内镜能提高1次双气囊内镜明确诊断率。     

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。     

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。     

胶囊内镜在老年人不明原因的消化道出血诊断中的应用

目的探讨M2A胶囊内镜对老年人不明原因的消化道出血的诊断作用。方法对27例不明原因消化道出血的老年患者进行M2A胶囊内镜检查，其中22例经过电子胃镜、结肠镜或小肠气钡双重造影检查，均未明确出血部位；另5例未做过任何检查。结果27例患者中，经M2A胶囊内镜检查发现出血病变20例，检出率为74．1％。检出病变主要为空肠血管发育不良6例，小肠多发息肉4例（其中1例为罕见的Cronkhite-Canada综合征），小肠占位性病变4例，小肠黏膜溃疡7例，小肠黏膜糜烂9例，小肠憩室1例，胃内小动脉出血2例，胃内黏膜糜烂、溃疡5例。有12例患者同时伴有2处或以上的病变。结论M2A胶囊内镜对不明原因的消化道出血部位有较高的检出率，是一种非侵人性的检查方法，尤其适用于老年患者。     

OMOM胶囊内镜在胃肠道疾病诊治中的应用

目的评价胶囊内镜对胃肠道疾病的诊断价值。方法对24例诊断不明的胃肠道疾病患者进行胶囊内镜检查。结果24例患者检查过程中均无任何不适。共检出病变19例，包括糜烂性胃炎2例，十二指肠炎2例，克罗恩病5例，小肠血管畸形7例，小肠息肉1例，小肠黏膜下占位1例（手术及病理证实为小肠肿瘤），升结肠憩室1例。余未见异常。阳性检出率79．2％。结论胶囊内镜检查操作简单、安全、有效，对消化道疾病尤其是小肠疾病有较高的诊断价值。     

胶囊内镜与双气囊小肠镜在诊断小肠疾病中的应用

常规内镜检查不能确定来源的持续或反复消化道出血,称为不明原因消化道出血（OGIB）。OGIB约占消化道出血的5％,多为小肠疾病所致,如血管病变、小肠肿瘤、Meckel憩室等。小肠气钡双重造影、放射性核素扫描、选择性腹腔动脉造影、推进式小肠镜等技术诊断小肠疾病敏感度低、漏诊率高。胶囊内镜（CE）和双气囊小肠镜（DBE）的相继诞生,开创了小肠疾病诊断的新时代。现对胶囊内镜及双气囊小肠镜检查小肠疾病的适应证、禁忌证、并发症及OGIB检出率等进行对比,综述如下。     

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.     

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.     

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。     

Clinical relevance of small-bowel findings detected by wireless capsule endoscopy

OBJECTIVE: Capsule endoscopy is becoming known as a valid tool for identifying sources of obscure gastrointestinal (GI) bleeding. Fewer data are available about its clinical value for other indications. MATERIAL AND METHODS: Sixty patients (31 F, mean age 47 years, range 14-80 years) with no signs of overt GI bleeding were investigated by Given M2A video capsule for suspected small-bowel disease. The main clinical features were: iron deficient anemia (20), abdominal pain (12), chronic diarrhea (9), malabsorption and weight loss (7), Crohn's disease (CD) (5), and familial adenomatous polyposis (3). Three patients underwent wireless endoscopy for suspected GI neoplasm and one for portal thrombosis. RESULTS: Complete vision of the small bowel was achieved in 55 patients. No small-bowel lesions were identified in 17 patients, but 5 of them had gastric abnormalities. Small-bowel abnormality was found in 38 patients. Lesions compatible with CD were found in 14 patients, diffuse or patchy enteropathy in 7 and polyps in 6. Actively bleeding lesions were detected in 6 patients and potential bleeding sources in 5. Capsule endoscopy had an overall diagnostic yield of 62%. In particular, three small-bowel malignancies were detected and 9 patients received a better definition of their already-known pathology. However, further endoscopies were needed in 10 patients to obtain a diagnosis. One patient, diagnosed with ileal CD, underwent surgery, as the capsule remained trapped in a stricture. CONCLUSIONS: Wireless endoscopy effectively visualizes small-bowel abnormalities even though more accurate selection of the patients is needed in order to optimize its diagnostic efficacy.     

How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions？

AIM: To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions. METHODS: Capsule endoscopic (CE) examination by using M2A capsule endoscope TM (Given Imaging, Yoqneam, Israel) was performed in thirty nine patients (26 males, 13 females) with suspected small intestinal lesions. The composing of the patients was as follows: obscure gastrointestinal bleeding in twenty three patients, known Crohn's disease in 6 patients, in whom CE was used to evaluate the severity and extension of the diseases, chronic diarrhea in 8 patients, abdominal pain in one patient and malignancy in one patient with unknown origin. RESULTS: In two patients CE failed. Different abnormalities were revealed in 26 patients overall. Detection rate of abnormalities was highest among patients with obscure gastrointestinal bleeding and the source of bleeding was demonstrated in 17 of 23 patients with obscure bleeding (73.9%). Entero-Behcet was diagnosed in two patients by CE as a source of obscure gastrointestinal bleeding. In 6 patients with known Crohn's disease, CE revealed better evaluation of the disease extension. In 3 of 8 (37.5%) patients with chronic diarrhea; CE revealed some mucosal abnormalities as the cause of chronic diarrhea. In a patient with unexplained abdominal pain and in a cancer patient with unknown origin, CE examination was normal. CONCLUSION: In our relatively small series, we found that capsule endoscopy is a useful diagnostic tool particularly in diagnosis of obscure gastrointestinal bleeding, chronic diarrhea and in estimating the extension of Crohn's disease.     

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.     

Capsule Endoscopy Versus Push Enteroscopy for Evaluation of Obscure Gastrointestinal Bleeding with 1-Year Outcomes

Because of the low diagnostic yield of standard radiologic tests for identifying sources of obscure gastrointestinal bleeding in the small intestine, we compared wireless video capsule endoscopy with push enteroscopy and small-bowel follow-through. Patients referred to Mayo Clinic, Scottsdale, Arizona, between August and December 2001 for evaluation of obscure gastrointestinal bleeding were potential candidates. Eligible patients had previously inconclusive endoscopy, colonoscopy, small-bowel follow-through, and other radiologic studies. Participants underwent capsule endoscopy and enteroscopy (within 24 hr). The primary end point was localization of any bleeding source, with 1-year telephone follow-up. Capsule endoscopy yielded positive findings in 10 of 20 patients (11 men; mean age, 69 years), 6 of whom had negative enteroscopy and small-bowel follow-through. No patient with negative findings on capsule endoscopy had positive findings on enteroscopy and small-bowel follow-through. At follow-up, 19 patients reported fewer transfusions, gastrointestinal procedures, and hospitalizations. Capsule endoscopy identified more lesions and improved outcomes.Published as an abstract at Digestive Disease Week, San Francisco, California, May 19–22, 2002.     

Capsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel

OBJECTIVE: The Given Capsule procedure is a new system designed to aid the gastroenterologist in diagnosing small-bowel disease. Capsule endoscopy has provided gastroenterologists with easy access to small-bowel mucosa for examination by direct visualisation. The aim of our prospective study was to determine the indication for capsule endoscopy and to describe the identified pathology within the gastrointestinal tract. METHODS: Patients with unexplained gastrointestinal bleeding from suspected small-bowel pathology of an undisclosed nature or with unexplained abdominal pain for more than 6 months were eligible to undergo capsule endoscopy. Patients with suspected intestinal obstruction or with a history of major abdominal surgery were excluded. RESULTS: One hundred and sixty patients (70 women, 90 men; mean age 49.0 +/- 19.8 years, range 13-91 years) ingested the capsule easily. They had undergone 6 +/- 2.9 investigative procedures before capsule endoscopy. Two (1.25%) patients who had non-natural excretions underwent surgery: one was found to have Meckel's diverticulum and the other had stricturing Crohn's disease. The mean haemoglobin in iron-deficiency anaemia patients was 9.1 +/- 2.2 g%. The diagnostic yield of capsule endoscopy was 57.7% in iron-deficiency anaemia and 52.4% in suspected Crohn's disease. CONCLUSIONS: Capsule endoscopy detected the more clinically significant intestinal lesions. It was of diagnostic value in patients with obscure bleeding, suspected Crohn's disease and malabsorption, but the diagnostic yield in patients with chronic pain or irritable bowel syndrome-type symptoms was low.