双气囊电子小肠镜在小肠疾病诊断中的应用价值

目的:探讨和评价双气囊电子小肠镜(DBE)对小肠疾病的诊断价值、安全性及适应症.方法:对怀疑或证实有小肠疾病的183例患者在异丙酚麻醉/镇静状态下进行210例次(经口检查61例,经肛门检查95例,双侧对接检查27例)DBE检查.结果:检查成功率为99.5%(209/210),平均检查时间75(30-180)min.小肠病变阳性检出率为71.0%(130/183),检出的主要病变有:小肠炎症性改变(n=43)、小肠Crohn病(n=19)、小肠血管发育不良(n=17)、小肠息肉(n=14)、小肠肿瘤(n=14,恶性10例,良性4例)、Peutz-Jeghers综合征(n=8)、小肠憩室及小肠寄生虫病各4例,其他少见小肠疾病7例.仅少数患者检查结束后有轻微咽部或肛门部疼痛不适和腹胀.结论:DBE能够对整个小肠进行直视检查,检查成功率高,安全可靠,对小肠疾病检出率高,可作为小肠疾病诊断的首选方法.     

Videocapsule endoscopy as a useful tool to diagnose primary intestinal lymphangiectasia

INTRODUCTION: Primary intestinal lymphangiectasia (Waldmann's disease) lead to a protein-losing enteropathy due to lymph leak into intestinal tract. EXEGESIS: A 28-year-old woman presented a bilateral lower limb lymphedema. Laboratory examination showing lymphopenia, hypoalbuminemia, hypogammaglobulinemia suggested the diagnosis of primary intestinal lymphangiectasia. Gastroscopy was normal and second duodenum biopsies were negative. Videocapsule endoscopy gave evidence of intestinal lymphangiectasia of the small bowel. CONCLUSION: Videocapsule endoscopy may be proposed to confirm intestinal lymphangiectasia and to precise their localization when gastroscopy is not conclusive.     

双气囊内镜检查对小肠溃疡病变的诊断研究

目的 研究双气囊内镜(DBE)检查对小肠溃疡病变的诊断价值.方法 统计2003年9月到2007年12月广州南方医院DBE检查发现的小肠单纯溃疡而内镜活检显示为"小肠溃疡"或"慢性炎症"者的资料.结果 符合以上条件者62例,其中男48例,女14例,年龄10～71岁,平均43.9岁.临床主诉为消化道出血38例(61.3%)、腹痛16例(25.8%)、腹胀5例(8.1%)、消瘦2例(3.2%)、腹泻1例(1.6%).DBE诊断为克罗恩病53例(85.5%)、药物性溃疡4例(6.5%)、慢性非特异性炎症2例(3.2%)、淋巴瘤2例(3.2%)、结核1例(1.6%).62例内镜活检常规病理全部为"慢性炎症".其中32例行手术治疗(51.6%),在DBE诊断为克罗恩病的30例中,手术后诊断为克罗恩病22例(3例合并癌变)、淋巴瘤4例、白塞病3例、小肠结核1例,DBE确诊率73.3%;DBE诊断的1例小肠结核和1例淋巴瘤,手术后诊断均为克罗恩病.62例小肠溃疡病变DBE总的确诊率为68.8%(22/32),误诊率达31.2%(10/32).结论 对小肠溃疡病变的定性诊断,DBE结合常规活检也不是特异的,常规病理结合免疫组化技术有可能提高诊断的准确率,当内科治疗效果不好时,适时外科手术对其诊断和治疗都是有益的.     

Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease

Evaluation of the small bowel has long been hampered because of its long and multiple complex loop configurations. Yamamoto et al have developed a new method of inserting an endoscope, known as the double-balloon method of enteroscopy, the Fujinon double-balloon endoscopy system being specialised for this application. Two types of endoscope are currently available for this technique. The EN-450 P5 is a thin endoscope for regular use, whereas the EN-450 T5 is a therapeutic double-balloon endoscope with a larger accessory channel of 2.8mm in diameter. Double-balloon endoscopy enables visualisation of the entire small bowel and also allows for interventional therapy in the small intestine. This method can be used either from an oral or an anal insertion. Observation of an affected area with controlled movement of the endoscope enables interventions, including biopsies, haemostasis, balloon dilatation, stent placement, polypectomy and endoscopic mucosal resection, to be performed. In our large study series, it was demonstrated that double-balloon endoscopy permitted exploration of the small intestine with the high success rate of total enteroscopy. The procedure is safe and useful, and it provides high diagnostic yields and therapeutic capabilities.     

单气囊小肠镜在小肠疾病诊治中的价值

目的评价单气囊小肠镜(Single balloon enteroscope,SBE)在小肠疾病诊断和治疗中的安全性及临床价值。 方法对2012年1月1日～2014年6月1日期间在我院行SBE检查的患者的临床资料进行回顾性分析,总结检查完成情况、操作时间、内镜诊断以及并发症发生情况等。 结果138例患者共行157次SBE检查。经口检查77例次;经肛检查80例次;经口联合经肛检查14例。共99例发现病变,疾病检出率为71.7%(99/138)。经口进镜检查平均用时45.5 min,经肛进镜检查平均用时50.3 min。所有患者检查过程中生命体征处于安全范围,无心脑血管并发症发生,无剧烈腹痛及出血、穿孔等并发症出现。 结论SBE可以安全,高效的完成小肠疾病的诊治,相信随着临床经验的积累,SBE会在小肠疾病的诊断中发挥更大的作用。     

Videocapsule endoscopy is useful for the diagnosis of intestinal lymphangiectasia

We study two authentic cases of protein-losing enteropathy, the diagnosis of which was facilitated using Given M2A videocapsule endoscopy. The first case corresponded to a primary intestinal lymphangiectasia confirmed by jejunum biopsies and the second one to a protein-losing enteropathy with lymphatic abnormalities secondary to a chronic constrictive pericarditis. In the first case, the mucosa of jejunum presented with a diffuse oedematous aspect, whitish villi, white curved lines probably related to submucosal dilated lymphatics and lacteal juice. In the second case, capsule endoscopy showed oedematous aspect of jejunum mucosa associated with white curved lines similar to those observed in the first case. Videocapsule endoscopy is useful in cases of protein-losing enteropathy to identify presence of intestinal lymphangiectasia and to specify their localisation after ruling out other disorders liable to induce protein-losing gastrointestinal syndrome.     

双气囊内镜检查是提高小肠疾病诊治水平的重要方法

小肠冗长迂曲,既往诸多的检查方法如口服钡餐全消化道造影、动脉血管造影、核素扫描等虽然在小肠疾病的诊断中各自发挥了一定的作用,但小肠疾病的诊治并没有突破性进展,直到近年来胶囊内镜和双气囊内镜的相继出现并逐步普及,才使小肠疾病的临床诊治水平有了突破性进展.     

Double balloon endoscopy associated pancreatitis： A description of six cases

AIM： To perform a single-center analysis of all double balloon endoscopy （DBE） related cases of pancreatitis identified prospectively from a recorded DBE- complication database.
METHODS： From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Outcome measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, procedure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization.
RESULTS： This is the largest single-center study reporting on post-DBE pancreatitis prospectively. Six patients （1.0%） developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years （range 25-78）. Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one.
CONCLUSION： The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.     

Double balloon enteroscopy: a useful tool for diagnostic and therapeutic procedures in the pancreaticobiliary system

OBJECTIVES:  Diagnostic and therapeutic interventions in the biliary and pancreatic system in the previously operated patient by conventional endoscopic retrograde cholangiopancreaticography (ERCP) are difficult and, depending on the surgical procedure, in many cases unsuccessful. We describe our experience of ERCP performed with a double balloon enteroscope (DBE) as an alternative examination technique for these patients.
METHODS:  In a retrospective analysis of all DBE procedures at our department between November 2004 and June 2007, 11 patients were identified with various anatomic variations in whom ERCP was performed using a DBE.
RESULTS:  In 72% of the patients, previous conventional ERCP examinations failed (8/11). In these patients, DBE-ERCP was successful in 63%. The overall success rate of DBE-ERCP in all patients was 64% (7/11 patients). In those patients, interventions such as papillotomy, calculus extractions, as well as stent placement could be performed even though tools for DBE-ERCP are still very limited. Despite most of the DBE-ERCPs having included therapeutic interventions, no major complications occurred in our case series and minor side effects were restricted to meteorism and mild to moderate abdominal pain.
CONCLUSIONS:  DBE-ERCP is an alternative method for diagnostic as well as therapeutic interventions in the biliary as well pancreatic system in the operated patient. However, it should be limited to selected patients, e.g. , with contraindications for PTC, as it is a time-consuming as well as a cost-intensive procedure.     

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。     

胶囊内镜对小肠疾病诊断和治疗的影响程度

目的:了解胶囊内镜的运用对小肠疾病患者诊断和治疗方案抉择的影响.方法:分析我科自2002-03/2006-08进行胶囊内镜检查的健康查体者84例,门诊或住院患者204例,比较胶囊内镜检查前后患者诊断和治疗的变化情况.结果:84例无症状查体者病变检出率为53.57%(45/84),其中需药物治疗者占48.89%(22/45),需随访监测,必要时进行其他检查或医疗干预者22.22%(10/45),不需要处理者28.89%(13/45).204例患者均接受过2种以上的消化道检查,症状持续时间平均为50 mo.不明原因消化道出血的病变检出率较高,为76.47%:腹痛、腹泻和腹胀的病变检出率分别为68.49%,61.90%和66.67%.204例有症状患者在胶囊内镜检查后诊断及治疗完全变更36.76%(75/204),胶囊内镜检查对诊断和治疗变更的总有效影响率为77.94%(159/204).结论:胶囊内镜是小肠疾病诊断的理想工具,对小肠疾病患者诊断和治疗的最后确定具有重要的影响,也是小肠疾病"早期诊断"、"早期治疗"能得以实现的保障.     

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.     

Comparative study of intestinal tuberculosis and primary small intestinal lymphoma

AIM:To characterize the clinical,radiological,endoscopic and pathological features of intestinal tuberculosis(ITB)and primary small intestinal lymphoma(PSIL).METHODS:This was a retrospective study from February 2005 to October 2012 of patients with a diagnosis of ITB(n=41)or PSIL(n=37).All patients with ITB or PSIL underwent computed tomography(CT)and pathological examination.Thirty-five patients with ITB and 32 patients with PSIL underwent endoscopy.These patients were followed for a further 18 mo to ascertain that the diagnosis had not changed.Clinical,endoscopic,CT and pathological features were compared between ITB and PSIL patients.RESULTS:Night sweating,fever,pulmonary TB and ascites were discovered significantly more often in ITB than in PSIL patients(P<0.05),however,abdominal mass,hematochezia and intestinal perforation were found significantly more frequently in PSIL than in ITB patients(P<0.05).Ring-like and rodent-like ulcers occurred significantly more often in ITB than in PSIL patients(P<0.05),however,enterorrhagia and raised lesions were significantly more frequent in PSIL than in ITB patients(P<0.05).The rate of granuloma was significantly higher in ITB than in PSIL patients(87.8%vs 13.5%,χ2=43.050,P<0.05),and the incidence of confluent granulomas with caseous necrosis was significantly higher in ITB than in PSIL patients(47.2%vs0.0%,χ2=4.034,P<0.05).Multi-segmental lesions,mural stratification,mural gas sign,and intestinal stricture were more frequent in ITB than in PSIL patients(P<0.05),however,a single-layer thickening of bowel wall,single segmental lesions,and intussusception were more common in PSIL than in ITB patients(P<0.05).Necrotic lymph nodes,comb sign and inflammatory mass were more frequent in ITB than in PSIL patients(P<0.05).The bowel wall enhancement in ITB patients was greater than that in PSIL patients(P<0.05),while the thickening and lymph node enlargement in PSIL patients were higher than those in ITB patients(P<0.05).CONCLUSION:Combined evaluation of clinical,radiological,endoscopic and pathological features is the key to differentiation between ITB and PSIL.     

原发性小肠淋巴瘤临床病理特点及诊治进展

原发性小肠淋巴瘤(primary small intestinall ymphoma,PSIL)是一种结外淋巴瘤,其临床表现缺乏特异性,其组织分型、病理形态与结内淋巴瘤有所不同,临床易误诊漏诊,病理诊断较困难,明确其分类、分期标准有助于提高临床及病理诊断水平.其治疗与结内淋巴瘤及其他胃肠道肿瘤不同,目前采取以手术为主以放化疗为辅的综合治疗.本文对该病的临床病理特点、分型、诊治及预后进行综述.     

Familial lymphoma including a report of familial primary upper small intestinal lymphoma

Summary Presented are 3 families with lymphoma. Evidence is given regarding the possible significance of lymphoma in these families not that they disprove a genetic predisposition but that they are confirmatory to our present hypotheses regarding environmental factors and lymphoma, especially primary upper small intestinal lymphoma.

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Zusammenfassung Es wird über 3 Familien mit Lymphomen berichtet. Auf Grund der möglichen Signifikanz des Auftretens von Lymphomen in diesen Familien wird zwar die genetische Prädisposition als Ursache nicht widerlegt; es wird jedoch gleichzeitig auch unsere Hypothese bestätigt, die den Zusammenhang zwischen Umweltfaktoren und der Entstchung von Lymphomerkrankungen zum Gegenstand hat, insbesondere für das primäre Lymphom des oberen Dünndarms.

     

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。     

双气囊小肠镜在诊断小肠克罗恩病中的价值

目的 探讨双气囊小肠镜在诊断小肠克罗恩病中的价值.方法 对65例临床怀疑小肠克罗恩病的患者进行检查,并与先前进行的插管法小肠钡灌肠和胶囊内镜检查结果进行对比分析.结果 65例患者行双气囊小肠镜检查诊断为小肠克罗恩病58例,并经病理和临床随访确诊.其中45例患者首选从肛门进镜行小肠镜检查,确认克罗恩病34例（75.6%）,另11例后从口腔进镜,发现病变者8例（72.7%）;20例首选经口进镜,检出克罗恩病11例（55%）,另9例患者日后经肛进镜检查中检出5例（55.6%）.先前进行的46例小肠钡灌肠检查中,24例诊断或疑似小肠克罗恩病,诊断率为52.2%,与小肠镜结果比较,符合小肠克罗恩病诊断例数为18例,诊断正确率为75%（18/24）.22例胶囊内镜检查者中,14例诊断或疑似小肠克罗恩病,诊断率为63.6%,最终经双气囊小肠镜确诊的病例数为11例,诊断准确率为78.6%（11/14）.结论 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;双气囊小肠镜是小肠克罗恩病诊断的较为理想的方法,并能对病变范围和严重程度作出正确判断,插管法小肠钡灌肠是一项决定小肠镜进镜方式选择上有价值的筛选性手段.