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。     

Age and Video Capsule Endoscopy in Obscure Gastrointestinal Bleeding: A Prospective Study on Hospitalized Patients

Background  

The influence of aging on video capsule endoscopy (VCE) in obscure gastrointestinal bleeding (OGIB) has never been prospectively assessed.     

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.     

不明原因消化道出血的诊断和处理

不明原因消化道出血(OGIB)的诊断和处理曾是内科医师和消化科医师面临的挑战。胶囊内镜和双气囊小肠镜检查的发展使OGIB的处理发生了根本的变革。本文讨论OGIB的病因、诊断检查手段和诊断处理流程。此外,对OGIB最常见的病因—血管发育不良采用联合激素、奥曲肽或沙利度胺等药物治疗也一并予以讨论。     

A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Aims  

Video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding.     

Factors Associated with the Clinical Impact of Capsule Endoscopy in Patients with Overt Obscure Gastrointestinal Bleeding

Background and Study Aims  

Capsule endoscopy (CE) does not necessarily identify positive findings in patients with overt obscure gastrointestinal bleeding (OGIB). We aimed to identify factors predictive of positive CE findings and those of re-bleeding after negative CE in overt OGIB.     

Comparative Evaluation of Barium Meal Follow-Through and Barium Enteroclysis before Capsule Endoscopy in Obscure Gastrointestinal Bleeding

Background/Aims: Small bowel radiological investigations have lower diagnostic yield in comparison to capsule endoscopy (CE) and are inaccurate in predicting capsule impaction. Most studies have used barium meal follow-through (BAMFT) and more sensitive barium enteroclysis (BE) is infrequently used. This study was done to retrospectively compare results of performing BAMFT or BE before CE in patients with obscure gastrointestinal bleeding. Methodology: Sixtyfive patients with obscure gastrointestinal bleeding underwent barium examination (BE or BAMFT depending upon patient's preference) and CE was performed if barium examination was normal. The demographic data, barium examination results and CE findings were retrospectively collected. Results: Sixteen patients underwent BAMFT and 49 patients underwent BE prior to CE. BAMFT was normal in all 16 patients whereas CE was normal in only 1/16 patient. Seven of 49 (14.2%) patients had stricture or mass on BE. In these 7 patients CE was not performed. In contrast to BAMFT, 22/41 (53.6%) patients with normal BE had normal CE findings also. The capsule got stuck in one patient with NSAID induced diaphragm disease who had normal BE and required surgical removal. Conclusions: BE should be preferred over BAMFT as the radiological imaging technique for evaluation of small bowel before CE in patients with obscure gastrointestinal bleeding as it may detect unexpected strictures and intraluminal masses. However, radiological findings either on BAMFT or BE cannot predict passage of capsule endoscope through small bowel.     

Diagnostic Yield and Impact of Capsule Endoscopy on Management of Patients with Gastrointestinal Bleeding of Obscure Origin

This study assessed diagnostic yield and impact of capsule endoscopy on patient management. Seventy-five patients with obscure gastrointestinal bleeding were included. Clinical and followup information was collected by review of patient records and with personal contact with the referring physicians. All previous clinical information and interventions after capsule endoscopy and clinical outcome were noted. The indication was obscure-overt gastrointestinal bleeding in 36 patients (48%) and obscure-occult gastrointestinal bleeding in 39 patients (52%). Overall diagnostic yield was 66.7% considering relevant lesions. Followup was available in 31 patients. Capsule endoscopy changed clinical management in 61.4%. Multivariate analysis showed that patients with another potential source of bleeding and patients whose onset was hematochezia were not good candidates for capsule endoscopy. Capsule endoscopy has a high diagnostic yield and a positive influence on clinical management in a high proportion of patients with obscure gastrointestinal bleeding.     

Capsule Endoscopy for Obscure GI Bleeding: Therapeutic Yield of Follow-up Procedures

Positive findings on capsule endoscopy (CE) often prompt a follow-up procedure with therapeutic intent. Our purpose was to review the therapeutic yield of subsequent procedural interventions based on positive CE findings. The medical records of all patients who underwent CE between June 2002 and February 2005 for obscure bleeding were retrospectively reviewed. Fifty-two patients had follow-up procedures based on positive capsule findings. In this group, angiodysplasia was the most common CE finding (n=30), with therapeutic intervention performed in 16 cases (53%). Fresh blood without clear lesion was the second most common finding (n=9), with therapeutic intervention performed in 6 cases (67%). Overall, a therapeutic intervention was performed in 33 of the 52 follow-up procedures (63%). Positive capsule findings directed further procedural investigation in 52 cases, with a high therapeutic yield of 63% in those cases. The long-term efficacy of such interventions warrants further investigation.