胶囊内镜和器械辅助式小肠镜在小肠肿瘤诊断中应用的系统评价

背景:小肠肿瘤起病隐匿、进展缓慢、无特异性临床表现,早期诊断较为困难。胶囊内镜(CE)和器械辅助式小肠镜(DAE)的应用为小肠肿瘤诊断开辟了新方向。目的:对CE和DAE在小肠肿瘤诊断中的应用进行系统评价。方法:计算机检索PubMed数据库(2002年1月～2012年3月),纳入应用CE和DAE检查诊断小肠肿瘤的文献,采用STATA 11.0统计软件进行系统分析。结果:共纳入21篇文献。系统分析显示CE和DAE对小肠肿瘤的检出率分别为4.2%和9.7%。不明原因消化道出血(OGIB)是患者接受CE或DAE的主要原因。间质瘤、腺癌、神经内分泌肿瘤(NET)、淋巴瘤以及息肉综合征是最常见的小肠肿瘤类型。57.1%的小肠肿瘤发生在空肠。DAE的活检诊断率为75.7%。CE和DAE的不良反应发生率分别为11.3%和3.8%。内镜指导干预率为86.1%。结论:小肠肿瘤常见的肿瘤类型为间质瘤、腺癌、NET和淋巴瘤,发生部位以空肠多见。CE和DAE可提高小肠肿瘤的检出率,具有较高的有效性和安全性。     

Non-small-bowel abnormalities identified during small bowel capsule endoscopy

AIM:To investigate the incidence of non-small-bowelabnormalities in patients referred for small bowel capsule endoscopy,this single center study was performed.METHODS:Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding.This is defined as bleeding from the digestive tract that persists or recurs without an obviousetiology after a normal gastroduodenoscopy and colonoscopy.Nevertheless,capsule endoscopy sometimesreveals findings outside the small bowel,i.e.,withinreach of conventional endoscopes.In this retrospectivesingle center study,595 patients undergoing capsuleendoscopy between 2003 and 2009 were studied.Theincidence of non-small bowel abnormalities was defined as visible abnormalities detected by capsule endoscopy that are located within reach of conventionalendoscopes.RESULTS:In 595 patients,referred for obscure gastrointestinal bleeding or for suspected Crohn’s disease,abnormalities were found in 306(51.4%).Of these 306patients,85(27.7%)had abnormalities within reach of conventional endoscopes;63 had abnormalities apparently overlooked at previous conventional endoscopies,10 patients had not undergone upper and lower endoscopy prior to capsule endoscopy and 12 had abnormalities that were already known prior to capsule endoscopy.The most common type of missed lesions were vascular lesions(n=47).Non-small-bowel abnormalities were located in the stomach(n=15),proximal small bowel(n=22),terminal ileum(n=21),colon(n=19)or at other or multiple locations(n=8).Ten patients with abnormal findings in the terminal ileum had not undergone examination of the ileum during colonoscopy.CONCLUSION:A significant proportion of patients undergoing small bowel capsule endoscopy had lesions within reach of conventional endoscopes,indicating that capsule endoscopy was unnecessarily performed.     

非特异性小肠炎40例随访分析

目的通过随访分析40例非特异性小肠炎患者,探讨其预后。方法分析郑州大学第一附属医院2010年9月-2012年10月行内镜检出非特异性小肠炎病变患者的临床表现、内镜表现、病理特点、诊疗及随访情况。结果 40例小肠病变患者,11例患者在内镜检出病变前很长一段时间(平均3.7年)被诊断为功能性肠病,2例是无症状患者,其余患者均伴有不同程度肠道症状。病变位于回肠末端25例、空肠8例、回肠(不包括回肠末端)6例、十二指肠1例;内镜下表现为黏膜糜烂20例、黏膜充血19例、黏膜结节隆起1例;病理表现为慢性炎25例、慢性炎伴肉芽组织增生9例、慢性炎伴淋巴组织增生6例。治疗后内镜下治愈40例,无复发病例;症状治愈29例,缓解11例。在整个随访过程中,未见明显严重并发症如肠梗阻、穿孔等。结论本组报道的非特异性小肠炎预后良好。同时,进一步推广和普及胶囊内镜(CE)、小肠镜检查并重视结肠镜回肠末端检查有助于推动对非特异性小肠炎的深入研究。     

Capsule endoscopy:Current practice and future directions

Capsule endoscopy(CE)has transformed investigation of the small bowel providing a non-invasive,well tolerated means of accurately visualising the distal duodenum,jejunum and ileum.Since the introduction of small bowel CE thirteen years ago a high volume of literature on indications,diagnostic yields and safety profile has been presented.Inclusion in national and international guidelines has placed small bowel capsule endoscopy at the forefront of investigation into suspected diseases of the small bowel.Most commonly,small bowel CE is used in patients with suspected bleeding or to identify evidence of active Crohn’s disease(CD)(in patients with or without a prior history of CD).Typically,CE is undertaken after upper and lower gastrointestinal flexible endoscopy has failed to identify a diagnosis.Small bowel radiology or a patency capsule test should be considered prior to CE in those at high risk of strictures(such as patients known to have CD or presenting with obstructive symptoms)to reduce the risk of capsule retention.CE also has a role in patients with coeliac disease,suspected small bowel tumours and other small bowel disorders.Since the advent of small bowel CE,dedicated oesophageal and colon capsule endoscopes have expanded the fields of application to include the investigation of upper and lower gastrointestinal disorders.Oesophageal CE may be used to diagnose oesophagitis,Barrett’s oesophagus and varices but reliability in identifying gastroduodenal pathology is unknown and it does not have biopsy capability.Colon CE provides an alternative to conventional colonoscopy for symptomatic patients,while a possible role in colorectal cancer screening is a fascinating prospect.Current research is already addressing the possibility of controlling capsule movement and developing capsules which allow tissue sampling and the administration of therapy.     

第二代结肠胶囊内镜临床应用的初步探讨

目的初步探讨第二代结肠胶囊内镜的临床应用。方法纳入2017年7月至2018年12月于浙江大学医学院附属第一医院行结肠胶囊内镜检查的所有门诊和住院患者40例。由具有小肠或结肠胶囊内镜丰富判读经验的消化内科主任医师分析检查结果,观察胶囊在胃、小肠和结肠的通过时间,以及结肠清洁程度评分、胶囊检查完成率、病变检出情况和检查过程中的不良反应。采用卡方检验和Student′t检验进行统计学分析。结果65.0%(26/40)的患者在胶囊运行时间内完成全消化道检查,胃通过时间为(0.92±0.74)h,小肠通过时间为(3.93±1.51)h,结肠通过时间为(4.89±0.61)h。完成全消化道检查患者的胶囊运行时间短于未完成全消化道检查者[(9.44±3.53)h比(15.47±2.09)h],差异有统计学意义(t=6.79,P<0.01)。结肠准备合格率为67.5%(27/40)。结肠准备合格患者胶囊结肠通过时间、胶囊排空时间与结肠准备欠佳患者比较[分别为(4.43±3.33)h比(5.96±2.44)h,(9.06±3.91)h比(10.29±2.47)h]差异均无统计学意义(t=1.17、0.81,P均>0.05)。结肠胶囊内镜共发现33例(82.5%)患者存在消化道病变,其中食管病变3例,包括炎症与占位;胃病变21例,包括慢性胃炎、黏膜隆起、息肉和溃疡;小肠病变9例,包括息肉、溃疡和血管畸形;结肠病变19例,包括憩室、息肉、直肠炎、溃疡和糜烂、血管畸形、内痔;存在2种及以上病变的患者有11例。所有患者在检查过程中均未出现任何不良反应,均在吞入胶囊48 h内排出胶囊。结论第二代结肠胶囊内镜可用于全消化道检查,具有较高的安全性和耐受性。     

Wireless capsule endoscopy in a community gastroenterology practice

GOALS: This study was performed to evaluate the use of wireless capsule endoscopy in a community gastroenterology practice. BACKGROUND: Experience with wireless capsule endoscopy at referral centers has been reported, but little has been reported about community gastroenterologists' experience. STUDY: A retrospective review of charts and wireless capsule endoscopies performed at a community hospital was performed. RESULTS: A total of 99 wireless capsule endoscopies were reviewed and complete data were available in 72 cases. Indications included suspected obscure GI bleeding in 97% of cases; 55% of patients were taking anti-platelet or anti-coagulant medications; 71% of examinations were complete. Pathologic findings included angioectasias (36%), gastritis/erosions (21%), bleeding (18%), small bowel ulcers (16%), duodenitis (7%), and small bowel erosions (6%). Strictures, Crohn's disease, and tumors were each seen in 3%. There were no abnormal findings in 37%. One complication, nonnatural excretion of the capsule, caused a transient bowel obstruction but passed without endoscopic intervention or surgery. CONCLUSIONS: In a community-based gastroenterology setting, wireless capsule endoscopy is a safe tool that shows abnormalities in a significant proportion of exams.     

Small-Bowel Tumors Detected by Wireless Capsule Endoscopy

Small bowel tumors are difficult to diagnose because of their endoscopic inaccessibility. This has been overcome by the use of the Pillcam™ SB capsule (Given Imaging, Yoqneam, Israel). The purpose of this report is to describe the largest series of patients with small bowel tumors detected by capsule endoscopy. Eighty six patients were derived from the Given Imaging clinical database on a survey of Pillcam™ SB capsule users who were diagnosed with 87 small bowel tumors, 1 cecal tumor, and 1 gastric tumor. The population consisted of 55 males and 31 females. 69% of patients were referred for capsule endoscopy for obscure gastrointestinal bleeding (59/86 patients) and 31% (27/86 patients) were referred for other indications including anemia, polyposis, and abdominal pain. All patients have histologically confirmed tumors. Eighty six patients reported 395 previous negative procedures (average of 4.6 per patient). Malignant tumors comprised 61% (54/89) and benign 39% (35/89). Of the 87 reported small bowel tumors, 4 were identified in the duodenum, 43 tumors were identified in the jejunum, 18 tumors were identified in the ileum, and 22 tumors were located in the mid to distal small bowel. The most common malignant tumors were adenocarcinoma, carcinoids, melanomas, lymphomas, and sarcomas. The most common benign tumors were GIST, hemangiomas, hamartomas, adenomas, and granulation tissue polyps. Capsule endoscopy is the diagnostic procedure of choice in patients with suspected small bowel tumors.     

Enteroscopy in children and adults with inflammatory bowel disease

Inflammatory bowel disease(IBD) includes Crohn's disease(CD), ulcerative colitis and unclassified entities. CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB) in about 30% of the patients, especially in the young ones. Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up. The introduction of cross-sectional imaging techniques and capsule endoscopy(CE) have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa. The main CE limitations are the low specificity, the lack of therapeutic capabilities and the impossibility to take biopsies. Device assisted enteroscopy(DAE) enables histological confirmation when traditional endoscopy, capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation, intralesional steroid injection, capsule retrieval and more recently stent insertion. In the current review we will discuss technical aspect, indications and safety profile of DAE in children and adults with IBD.     

胶囊内镜下小肠黏膜特征分析53例

目的:回顾性分析胶囊内镜检查患者53例,认识胶囊内镜下小肠正常黏膜特征及小肠病变黏膜特征.方法:2010-08/2011-08,利用Miro Cam胶囊内镜系统对患者53例行胶囊内镜检查.统计患者的年龄、性别、症状、体征等临床资料,将受检者分为不明原因的消化系出血,疑为功能性胃肠病,腹痛、腹泻、腹胀,便秘,体检等共5组;通过查阅病案及电话回访,搜集资料,将胶囊内镜下所见作出最终的临床诊断;分析胶囊内镜下小肠正常及病变黏膜特征.结果:在53例患者中,1例因吞服胶囊后无图像信号,未能顺利完成胶囊内镜检查;1例因患者吞咽胶囊困难而无法进行;其余51例均顺利到达结肠,到达结肠率为96.22%.胃的平均运行时间为69.78 min,小肠的平均运行时间为513.25 min.48例有消化系疾病的阳性结果,3例未见异常,阳性率为90.57%.在所有疑诊小肠疾病的51例患者中,胶囊内镜小肠病变总的诊断率为92.15%(47/51);空肠及回肠阳性诊断率为52.94%,包括炎症12例(1例临床确诊为Crohn’s病),息肉3例,不明肿块3例,淋巴滤泡增生1例,疑似小肠淋巴管扩张7例,钩虫病1例;同时检出反流性食管炎1例;慢性胃炎26例,糜烂性胃炎7例,胃部息肉3例;结肠炎症3例,结肠息肉5例,大肠黑变病2例.胶囊均自然排出体外,无梗阻等并发症的发生.结论:Miro Cam胶囊内镜是一种非侵入性的检查手段,检查安全,顺应性好;在胶囊内镜下,正常小肠黏膜及病变黏膜均呈现出一定的特征.     

Upper and lower gastrointestinal endoscopy in children and adolescents with Crohn''s disease: A prospective study

Fifty-six children and adolescents with Crohn's disease were prospectively investigated with gastroscopy and colonoscopy irrespective of localizing symptoms or signs. Routine biopsies were taken from endoscopically normal and abnormal areas. A high incidence (71%) of upper gastrointestinal (GI) involvement was found. In 41%, these findings were instrumental in making the diagnosis. The ileum was viewed in 49 of the 56 cases. Overall, the upper GI tract was involved in 71%, the terminal ileum in 53%, and the colon in 86% (oesophagus 16%, body of stomach 46%, antrum 36%, duodenum 21%, terminal ileum 53%, caecum 69%, transverse colon 71%, sigmoid 60% and rectum 41%). Upper and lower gastrointestinal endoscopy with systematic biopsies should be performed early in the diagnostic assessment of children and adolescents with suspected inflammatory bowel disease to enable accurate diagnosis and assessment of extent of disease.     

Follicular Lymphoma with Extensive Gastrointestinal Tract Involvement: Follow-up by Capsule Endoscopy

Follicular lymphoma with gastrointestinal tract involvement is rare. We describe the case of a young woman with follicular lymphoma with multiple nodular lesions involving segments of the proximal jejunum and terminal ileum. The presenting symptom was chronic diarrhea. The diagnosis was made by endoscopy with histologic examination of the mucosal lesions of the proximal and distal small intestine, immunohistochemical staining, and molecular analysis. The initial spread and pattern of the small bowel involvement, as well as treatment response, were evaluated by videocapsule endoscopy. The application of molecular analysis along with immunophenotypic evaluation has made it possible to precisely diagnose follicular lymphoma. In the present case, the use of capsule endoscopy improved the evaluation of the extent of small bowel involvement prior to and following treatment.     

A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes

BACKGROUND: Capsule endoscopy has demonstrated its clinical utility in the evaluation of the small bowel, and, accordingly, it has been suggested that it could be useful for the identification of small-intestinal polyps in patients with polyposis syndromes. The objective was to establish the effectiveness of wireless capsule endoscopy for detecting small-bowel polyps in patients with hereditary GI polyposis syndromes in comparison with barium contrast series. METHODS: Consecutive patients with GI polyposis syndromes were included. Small-bowel follow-through series and capsule endoscopy were performed within 1 week, in a blind fashion. The number and the location of polyps were analyzed. RESULTS: Twenty-four patients with familial adenomatous polyposis (n = 20) or Peutz-Jeghers syndrome (n = 4) were included. Capsule endoscopy detected small-bowel polyps in 7 of 24 patients (29%), whereas a barium contrast study identified small-intestinal polyps in only 3 of these 7 patients. In the 4 remaining patients, all of them with familial adenomatous polyposis, polyps detected by the capsule but missed in radiographic series were located at either ileum (2 patients), jejunum (1), or duodenum (1). No procedure-related complication was observed in any patient. CONCLUSIONS: Wireless capsule endoscopy is a highly accurate technique for the detection of small-bowel polyps in patients with hereditary GI polyposis syndromes, and it represents a valuable alternative to barium contrast series in the surveillance of patients with Peutz-Jeghers syndrome.     

Clinical application of wireless capsule endoscopy

BACKGROUND: Diagnostic modalities for identifying lesions within the small bowel have been quite limited. Wireless capsule endoscopy (WCE) is a new, innovative technique that can detect very small mucosal lesions in the entire small bowel and can be used in the outpatient setting. The present study explored the diagnostic value, tolerance and safety of WCE in the identification of small bowel pathology that was not detected with conventional small bowel imaging studies. METHODS: From May through September 2002, 15 patients with suspected small bowel diseases were prospectively examined, Of them, 12 presented with persistent obscure gastrointestinal bleeding and negative findings on upper endoscopy, colonoscopy, small bowel radiography, and bleeding‐scan scintig‐raphy or mesenteric angiography. RESULTS: Wireless capsule endoscopy identified pathologic small bowel findings in 11 of the 15 patients (73%): angioectasias, Dieulafoy's lesion, polypoid lesion, submucosal mass, Crohn's disease, carcinoid tumor, lipoma, aphthous ulcer, and hemorrhagic gastritis; four of the patients had two lesions. The images displayed were considered to be good. The capsule endoscopes remained in the stomach for an average of 82 min (range 6?311 min) and the mean transit time in the small bowel was 248 min (range 104?396 min). The mean time of recording was 7 h 29 min (from 5 h to 8 h 30 min). The mean time to reach the cecum was 336 min (180?470 min). The average number of the images transmitted by the capsule was 57 919 and the average time the physician took to review the images transmitted by the capsule was 82 min (range 30?120 min). The average time of elimination of the capsule was 33 h (range 24?48 h). All 15 patients reported that the capsule was easy to swallow, painless, and preferable to conventional endoscopy. No complications were observed. CONCLUSIONS: Wireless capsule endoscopy is safe, well tolerated, and useful for identifying occult lesions of the small bowel, especially in patients who present with obscure gastrointestinal bleeding.     

The Clinical Significance of Incidental Computer Tomography Finding of Gastrointestinal Luminal Wall Thickening as Evaluated by Endoscopy

The widespread use of computerized tomography in evaluating patients with various abdominal complaints gave rise to reports of incidental gastrointestinal luminal wall thickening (GILWT), the clinical significance of which remains uncertain. In order to determine the endoscopic significance of GILWT we reviewed 1609 abdominal and/or pelvic CT scans. Ninety-two patients with GILWT were identified. Patients with obvious clinical cause of this abnormality were excluded from the study. The median age of the patients was 58 years, with no significant difference in gender distribution. The GILWTs were distributed along the GI tract as follows: 24 upper (esophageal, gastric, and duodenum), 13 small intestine (jejunum and ileum), 3 combined small and large intestine, and 52 colon. Fifty of these patients underwent endoscopic evaluation. Six patients (12%) had cancer, all of which involved the colon. The endoscopy was unremarkable in 19 (38%) and revealed a nonmalignant finding in the remaining 25 patients (50%). None of the upper GI or small bowel GILWTs were malignant, while 6 of the 34 colonic GILWTs (18%) were malignant. The mean age of the colonic GILWT group was 59. None of the patients younger than 50 had cancer, while 6 of the 24 older patients (25%) had colon cancer. We conclude that as GILWT is not a common finding and could be the initial presentation of malignancy, particularly when involving the colon in patients older than 50, endoscopic evaluation should be strongly recommended in patients who do not have an alternative diagnosis that can satisfactorily explain GILWT.     

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.     

What we have learned and what to expect from capsule endoscopy

Capsule endoscopy was conceived by Gabriel Iddan and Paul Swain independently two decades ago. These applications include but are not limited to Crohn’s disease of the small bowel, occult gastrointestinal bleeding, non steroidal anti inflammatory drug induced smallbowel disease, carcinoid tumors of the small bowel,gastro intestinal stromal tumors of the small bowel andother disease affecting the small bowel. Capsule endoscopy has been compared to traditional small bowelseries, computerized tomography studies and pushenteroscopy. The diagnostic yield of capsule endoscopyhas consistently been superior in the diagnosis of smallbowel disease compared to the competing methods(small bowel series, computerized tomography, pushenteroscopy) of diagnosis. For this reason capsule en-doscopy has enjoyed a meteoric success. Image qualityhas been improved with increased number of pixels,automatic light exposure adaptation and wider angle ofview. Further applications of capsule endoscopy of other areas of the digestive tract are being explored. Theincreased transmission rate of images per second hasmade capsule endoscopy of the esophagus a realisticpossibility. Technological advances that include a double imager capsule with a nearly panoramic view of the colon and a variable frame rate adjusted to the movement of the capsule in the colon have made capsuleendoscopy of the colon feasible. The diagnostic ratefor the identification of patients with polyps equal to orlarger than 6 mm is high. Future advances in technology and biotechnology will lead to further progress.Capsule endoscopy is following the successful moderntrend in medicine that replaces invasive tests with lessinvasive methodology.     

Clinical utility of wireless capsule endoscopy: experience with 200 cases

GOALS: To evaluate the indications and diagnoses made with 200 small bowel capsule endoscopies in an academic medical center. BACKGROUND: Wireless capsule endoscopy (PillCam SB) has recently become available as a new tool in the evaluation of patients with small bowel diseases. Its impact on patient care and usefulness in clinical practice has steadily been gaining ground, yet there are few studies that evaluate large numbers of patients. METHODS: A retrospective review of wireless capsule endoscopies was performed between September 2003 and January 2005. Reviewed are the indications for the studies, number of complete and incomplete examinations, evaluation of gastric and small bowel transit times, findings made on examination, and the percent of diagnoses made and diagnoses suspected for each study indication. RESULTS: A total of 200 cases were reviewed. Indications included anemia (66% of cases), gastrointestinal hemorrhage (31% cases), abdominal pain (21% cases), diarrhea (11% cases), and other indications such as evaluation of abnormal radiographic findings or surveillance of inflammatory bowel disease (9% cases). The average patient age was 61.5 years (SD +/- 19.1 years). Males comprised 49% of patients. The wireless capsule endoscopy study completely evaluated the entire small bowel in 87% of cases. The most common cause for an incomplete examination was premature battery failure in 8% of cases. Only 9.5% of studies were normal without findings. Small bowel ulcerations were present in 38% of studies. Vascular ectasias were present in 23% of studies. Overall, a diagnosis was made in 23% of all studies, whereas a diagnosis was suspected based on the findings in an additional 31% of studies. The indication with the highest percentage of diagnoses made or suspected was gastrointestinal hemorrhage, with a diagnostic yield of 65%, followed by anemia 61%, diarrhea 36%, and pain 17%. CONCLUSIONS: Wireless capsule endoscopy is a valuable diagnostic tool in the evaluation of occult small bowel lesions, and was most effective in patients with gastrointestinal hemorrhage and anemia.     

术中内镜在胃肠手术中的应用价值

目的：探讨术中内镜在胃肠手术中的应用价值。方法：对32例胃肠手术的患者进行了术中内镜检查，其中25例为剖腹探查，7例为术前明确诊断但术中找不到病灶或难以确定病灶的边缘者。结果：25例剖腹探查术患者24例通过术中内镜明确了诊断，分别为：胃底Dieulafoy病1例，胃溃疡1例，十二指肠平滑肌瘤3例，小肠平滑肉瘤2例，十二指肠水平部Dieulafoy病1例，十二指肠水平部平滑肌瘤2例，回肠淋巴瘤2例，小肠腺瘤性息肉2例，加肠末段溃疡2例，小肠海绵状血管瘤3例，小肠动静脉畸形4例，胰空肠吻合口出血1例。所有32例患者除1例小肠息肉和1例结肠息肉予内镜下高频电切除术、1例未找到病灶而未予特别处理外，其余28例患者均进行了病变切除。结论：应用术中内镜不仅极大地提高了病变的检出率，而且能对病变准确定位。术中内镜诊疗术是安全且有效的。     

Iléocolite à éosinophiles idiopathique

Eosinophilic gastroenteritis is a rare and heterogeneous disorder characterized by eosinophilic infiltration into one or more layers of gastrointestinal tract. Although it can involve any part of the gastrointestinal tract, the stomach and the proximal small bowel are the most common sites of involvement. Ileocolitis location seems to be quite rare. It should be suspected in patients having gastrointestinal discomfort along with peripheral eosinophilia and where other diseases associated with peripheral eosinophilia had ruled out. We report herein two cases of Tunisian patients who presented with an unusual location of the disease at the terminal ileum and colon.     

PillCam COLON 2~ in Crohn's disease:A new concept of pan-enteric mucosal healing assessment

AIM: To evaluate mucosal healing in patients with small bowel plus colonic Crohn's disease(CD) with a single non-invasive examination, by using PillCam COLON 2.(PCC2).METHODS: Patients with non-stricturing nonpenetrating small bowel plus colonic CD in sustained corticosteroid-free remission were included. At diagnosis,patients had undergone ileocolonoscopy to identify active CD lesions, such as ulcers and erosions, and small bowel capsule endoscopy to assess the Lewis Score(LS). After ≥ 1 year of follow-up, patients underwent entire gastrointestinal tract evaluation with PCC2. The primary endpoint was assessment of CD mucosal healing, defined as no active colonic CD lesions and LS 135.RESULTS: Twelve patients were included(7 male;mean age: 32 years), and mean follow-up was 38 mo.The majority of patients(83.3%) received immunosuppressive therapy. Three patients(25%) achieved mucosal healing in both the small bowel and the colon,while disease activity was limited to either the small bowel or the colon in 5 patients(42%). It was possible to observe the entire gastrointestinal tract in 10 of the12 patients(83%) who underwent PCC2.CONCLUSION: Only three patients in sustainedcorticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, highlighting the limitations of clinical assessment when stratifying disease activity, and the need for pan-enteric endoscopy to guide therapeutic modification.