胶囊内镜对各段小肠的诊断价值探讨

目的探讨胶囊内镜在各段小肠中的诊断价值。方法 53例受检者行严格小肠肠道清洁,采用以色列GIVEN公司的SB胶囊内镜行全小肠检查。根据小肠肠腔特点和Given定位系统,将小肠分为3段。统计各段小肠的肠道清洁度、病变检出率和评价病灶表面特征的观察效果,对影响因素进行分析。结果全部受检者完成检查。47例受检者完成全小肠观察,10例受检者共发现13处观察效果不佳,约占总受检病例数的18.9%;其中第1、第2和第3段小肠发现清洁欠清晰数分别为4、1和8,分别约占总数的31.8%、7.7%和61.5%。42例受检者发现病变,共发现病灶约75处,部分病灶表面特征观察效果欠佳。3段小肠总病灶数无明显差异,但3段小肠的非炎症病灶数的百分比分别为:16.7%、50.0%和33.3%。结论胶囊内镜检测第2段小肠有良好观察效果及病变检出率;改进检查条件有助提高胶囊内镜在第1段和第3段小肠的诊断价值。     

Contraindications for video capsule endoscopy

Video capsule endoscopy(VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn's disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging(MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.     

Clinical application of video capsule endoscopy

BACKGROUND: Non-invasive imaging of the complete small bowel has become possible with the recently available video capsule endoscopy technique. The aim of this study was to review and assess the possibilities and limitations of the clinical application of video capsule endoscopy. METHODS: Literature review. RESULTS: Video capsule endoscopy is a new promising technique with good to excellent visualization of the mucosa of the small bowel. It has a high diagnostic yield in patients with occult gastrointestinal blood loss (OGIB) and Crohn disease (CD). Several other indications need further study. Compared to small-bowel X-ray and push enteroscopy, diagnostic yield appears to be superior. Video capsule endoscopy is very well tolerated by patients. Its most important limitation is the impossibility of taking biopsies and therapeutic interventions. CONCLUSION: Video capsule endoscopy is a promising new diagnostic tool for small-bowel disease.     

A prospective evaluation of the diagnostic value of video capsule endoscopy in patients initially classified as irritable bowel syndrome

BackgroundIrritable bowel syndrome (IBS) is characterized by chronic gastrointestinal dysfunction in the absence of detectable organic disease. The recently developed technique, video capsule endoscopy (CE), has been shown to be much more sensitive than traditional enterography in detecting mucosal changes in the small intestine. This study was performed to see if any earlier, not detectable by other standard methods, mucosal changes could be found in the small intestine in patients diagnosed as having IBS.MethodsAll consecutive women who, over the past five years, had received a well-founded diagnosis of IBS at the Department of Medicine were identified. Twenty-eight women, mean age 36 ± 12 years were willing to participate in the study. They underwent a CE after a pre-test with a dummy capsule. The actual IBS activity was estimated by the validated Gastrointestinal Symptom Rating Scale (GSRS) and Psychological General Well-Being (PGWB) Index questionnaires.ResultsThe duration of the IBS symptoms was a mean of 10 years (range 3–25). Symptoms were present, according to the scores of the GSRS and the PGWB index, at the time the patients underwent the CE. In the majority, 24 of 27 IBS patients examined, no specific small intestinal lesions were seen on CE. In two patients, CE revealed multiple small intestinal lesions such as ulcerations and/or erosions, and in one patient a duodenal ulceration.ConclusionIn the vast majority of patients who fulfil the symptom criteria of IBS, no pathological mucosal lesions can be found by CE explaining the symptomatology. However, a subgroup of these patients may benefit from investigation by CE to reconsider the diagnosis.     

The effect of erythromycin on video capsule endoscopy intestinal-transit time

BACKGROUND: Video capsule endoscopy (VCE) will fail to reach the cecum in 20% of patients within the 8-hour battery life. The use of prokinetics to improve VCE completion rates to the cecum remains unclear. The objective of this study was to determine whether erythromycin increases the completion rate of VCE to the cecum without adversely affecting image quality. METHODS: This was a prospective, randomized, single-blinded control trial at St. Vincent's Hospital, Melbourne, Australia. A total of 86 consecutive patients referred for VCE were considered for entry; 45 patients met the entry criteria. These 45 patients were prospectively randomized to no erythromycin (controls, n = 23) or 250 mg erythromycin (n = 22). Two gastroenterologists, who were unaware of which group the patients were randomized into, reported all VCEs. The number of VCEs that reached the cecum within the 8-hour study period, gastric emptying time (GET), and small-bowel transit time (SBTT) were calculated for each group. RESULTS: There was no significant difference in the number of VCEs that reached the cecum (32% failed to reach the cecum in the erythromycin group compared with 22% in the control group), GET, or SBTT between the two groups. Image quality was not adversely affected by the use of erythromycin. The dose and the preparation of erythromycin used in this study may have possibly had an effect on GET and SBTT. CONCLUSIONS: The use of erythromycin did not significantly increase the likelihood of the capsule reaching the cecum or affect the degree of visible peristalsis or the interpretation of capsule findings.     

Use of video capsule endoscopy in Crohn's disease

Capsule endoscopy has been available since 2001 to image the small intestine, a boon to practitioners managing patients with inflammatory bowel disease. During the last ten years, new technologies have been developed, including computed tomographic enterography, magnetic resonance enterography, in addition to our standard small bowel follow through, all of which image the small bowel. This has created a situation in which multiple options are available to the gastroenterologist to image the small bowel, each with strengths. This review focuses on capsule endoscopy as it pertains to the imaging of the small bowel in patients with known or suspected Crohn's disease. We will focus on comparative imaging data, how capsule endoscopy may aid in the prediction of disease type and course, the avoidance and meaning of capsule retention, along with cost considerations, and directions for the future.     

胶囊内镜图像筛选系统的临床应用价值

目的 评估本课题组开发的胶囊内镜图像筛选系统在临床中的应用价值.方法 利用OMOM胶囊内镜工作站收集2011年3月至6月间行胶囊内镜检查的50例患者的胶囊内镜全部图像数据,其中男29例,女21例,年龄13～ 67岁,平均(45.7±4.1)岁.用自主研发的胶囊内镜图像筛选系统分别按50％、60％、70％、80％及90％的比例进行无效图片处理后,由临床医生对剩余及筛除的图像分别进行阅读,并记录所有患者的病灶数量及保留病灶的数量,并计算病灶保留率;同时记录计算机处理图像的时间和病例图像的总量.结果 50例受检者中共发现病变39例,检出率为78.0％.39例病变中,共有病灶91处,大部分病例都包含2处以上病灶,最多可达9处.在系统设定筛除比例为≤60％时,病灶保留率可达100％,所有病例的图片总量平均为46 242张,图像筛选所需时间平均为15.62 min.结论 本系统在病灶完全保留的前提下,能在短时间内筛除60％的相似图片及无效图片,极大地缩短了阅片时间,减轻了临床医生的工作量,提高了临床胶囊内镜检查的效率.     

Upper gastrointestinal video capsule endoscopy: The state of the art

BackgroundVideo capsule can illuminate the entire gastrointestinal mucosa. Upper gastrointestinal capsule endoscopy (UGICE) has the potential to survey for oesophageal, gastric and duodenal pathology and determine whether biopsy or intervention is indicated.AimsThis review traces the evolution of foregut video capsule endoscopy.MethodsA broad literature research was performed independently by two investigators. Extracted articles were organized and evaluated to interpret all current data.ResultsIn contrast to small bowel capsule, UGICE required sequential innovations to deal with rapid oesophageal transit, the irregular shape of the stomach and unpredictable gastric peristalsis. Oesophageal capsule endoscopy required the development of a two-camera device operating at a high frame rate, and postural change was developed to improve image capture, especially at the level of the Z-line, thus providing good imaging of Barrett's oesophagus, erosive oesophagitis and oesophageal varices, with optimal patients’ tolerance. UGICE in patients presenting to the emergency room with acute bleeding has demonstrated accuracy when deciding on the need for emergency intervention. The latest development of a high frame rate UGICE, designed to image the oesophagus, stomach and duodenum has overtaken dedicated oesophageal capsule development. Capsule control is possible by exposing a magnetised capsule to an external magnetic field, and early reports indicate high accuracy in the oesophagus and stomach with high levels of patient acceptability. There is little information on cost-benefit.ConclusionsCapsule endoscopy offers gastroenterologists a new device to investigate the upper gastrointestinal tract with promising future potential.     

Small bowel video capsule endoscopy: an overview

Video capsule endoscopy (VCE) is being increasingly used to investigate small bowel pathology. It is the gold standard for obscure gastrointestinal bleeding and iron deficiency anemia. VCE has been in use since 2001 and indications for its use are expanding. VCE is also a useful diagnostic tool in small bowel Crohn’s disease, celiac disease, surveillance of polyps, small bowel malignancy and drug-induced small bowel injury. Although VCE is considered a safe and easy procedure, there are a few limitations. These include cost, capsule retention and inability to take a biopsy and perform any therapeutic maneuvers. Contraindications for VCE include pregnancy, patients with a swallowing disorder, history of previous abdominal surgery or concurrent abdomino–pelvic irradiation. This is an overview of VCE, its role and indications in clinical practice, potential complications and contraindications, as well as the ongoing and expected advances in the field.     

内镜对胆肠内瘘的诊断价值

目的 探讨内镜对胆肠内瘘的诊断价值。方法 回顾性总结分析1982年1月至2004年3月经内镜检查的24例胆肠内瘘患者的临床资料（均经手术证实）。结果 24例中经内镜确诊21例，其中在诊治过程的初期内镜误诊3例；内镜未能诊断3例。其他检查：B超检查11例、CT检查5例、X线腹部平片检查7例，无一例确诊；钡餐X线或钡剂灌肠X线检查8例，2例确诊。结论 内镜检查是诊断胆肠内瘘的重要方法。认识胆肠内瘘内镜表现特点可提高对该病的诊断水平。     

Technology Insight: current status of video capsule endoscopy

Video capsule endoscopy (VCE) is the most recent major practical and conceptual development in the field of endoscopy. The video capsule endoscope-a small, pill-sized, passive imaging device-has been demonstrated to be the pre-eminent imaging device for disorders of the small intestine. The initial use for VCE was to detect the origin of obscure gastrointestinal bleeding. Several other indications have now been justified, or are in the process of evaluation. More than 200,000 of these disposable devices have been used worldwide, with an extraordinarily good safety record: indeed, the device has been approved for use in children as young as 10 years of age. In addition, a double-ended capsule has now been approved for the evaluation of mucosal disease in the esophagus. The now-widespread deployment of the device into gastrointestinal practice in the US and many other countries suggests that VCE has achieved mainstream utility. The development of similar competitor devices, and devices whose movement can be controlled, is in progress.     

Wireless capsule video endoscopy：Three years of experience

AIM:To review and summerize the current literatue regarding M2A wireless capsule endoscopy.METHODS:Peer reviewed publications regarding the use of capsule endoscopy as well as our personal experience were reviewed.RESULTS:Review of the literature dearly showed that capsule endoscopy was superior th enteroscopy,small bowel follow through and computerized tomography in aptients with obscure qastrointestinal bleeding,iron deficiency anemia,or suspected Crohn‘s disease.It was very sensitive for the diagnosis of small bowel tumors and for survailance of small bowel pathology in patients with Gardner syndrome or familial adenomatous polyposeis syndrome.Its role in celiac disease and in patients with kmown Crohn‘s disease was currently being investigated.CONGLUSION:Capsule video endoscopy is a superior and more sensitive diagnostic tool than barium follow through,enteroscopy and entero-CT in establishing the diagnosis of many small bowel pathologyes.     

Strictures from Crohn's disease diagnosed by video capsule endoscopy

Video capsule endoscopy is a new diagnostic modality that allows imaging of the entire small intestine. We report on a patient with a presumed but undocumented case of Crohn's disease who was found to have 9 ileal strictures by video capsule endoscopy. These strictures were undetected by small intestinal contrast studies and required surgical intervention. This case report suggests that small bowel radiographic studies may not be as sensitive for the detection of clinically significant luminal lesions as once thought.     

胶囊内镜指导双气囊内镜进镜方式的临床研究

目的评估小肠疾病诊治中胶囊内镜（CE）对双气囊内镜（DBE）进镜方式的预测作用。方法将CE完成全小肠检查且其诊断经DBE证实者纳入研究。CE检出病灶的部位以时间指数（胶囊从幽门至病灶的通过时间占胶囊从幽门至回盲瓣通过时间的比例）表示,根据以往回顾性分析的结果采用0．6作为时间指数的临界值,时间指数不超过0．6时选择经口DBE检查,反之选择经肛检查。对最终结果进行统计学分析,评估根据病灶部位cE时间指数选择DBE进镜方式的准确性。结果最终共60例患者CE完成全小肠检查且其诊断经DBE证实而纳入研究。共行60例次DBE检查,包括41例经口和19例经肛检查,所有患者CE检出病灶均经首次DBE检查证实。对所得结果进行统计显示,根据cE时间指数临界值0．6,本组患者DBE进镜方式选择的准确性为100％。结论DBE是一项有效地证实CE诊断的方法,在cE完成全小肠检查者中根据CE时间指数能够准确判断DBE的进镜方式。     

小肠胶囊内镜的临床应用价值

小肠曾因其特殊的解剖位置而成为消化系统的检查盲区,自第一个批准用于临床的胶囊内镜上市以来,其简便、安全、无创的特点使小肠胶囊内镜被公认为目前诊断小肠疾病的一线工具,用于诊断不明原因消化道出血、缺铁性贫血、小肠肿瘤、克罗恩病等小肠疾病。文章就小肠胶囊内镜在小肠疾病诊断的临床应用及研究进展做一阐述。     

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。