11例不明原因小肠出血患者的临床分析

目的探讨胶囊内镜在不明原因小肠出血中的诊断价值、耐受性、并发症。方法回顾性分析11例不明原因小肠出血患者行胶囊内镜检查的结果。结果血管畸形4例,小肠肿瘤3例(其中经手术证实为空肠间质瘤1例,小肠癌1例,空肠胃黏膜异位1例),小肠钩虫病1例,检查阴性2例,出血影响观察1例。结论胶囊内镜检查安全、无创,病灶检出率较高,对不明原因小肠出血的诊断具有较高的临床意义,作为该类疾病首选检查方法。     

胶囊内镜诊断不明原因消化道出血42例的临床分析

目的探讨胶囊内镜在诊断不明原因消化道出血患者中的临床价值。方法分析本院2009年4月至2012年12月间42例不明原因消化道出血患者行胶囊内镜检查的临床资料。结果 42例患者顺利完成检查,共检出病变37例,阳性检出率为88%。包括血管畸形27例,小肠间质瘤1例,新鲜出血3例,小肠溃疡4例,小肠多发异常隆起1例,小肠钩虫病3例,小肠憩室1例,非特异性炎症11例,其中14例患者同时存在2种病变。胶囊内镜检查中无任何不适和并发症。结论胶囊内镜应用于临床以来,能够较好的对不明原因消化道出血相关病因做出诊断,其安全性高、顺应性好,并已成为诊断小肠疾病的重要手段。     

OMOM胶囊内镜对不明原因消化道出血30例患者检查分析

目的探讨国产OMOM胶囊内镜在不明原因上消化道出血诊断中的价值。方法 2010年12月至2012年6月应用国产OMOM胶囊内镜检查不明原因消化道出血30例。结果 30例患者中,检出病变24例,其中小肠溃疡10例,小肠腺瘤2例,腺癌2例;血管病变3例,寄生虫1例,小肠息肉2例,肠结核1例,小肠非特异性炎症3例。检查阳性率80%。结论 OMOM胶囊内镜安全,无痛苦,用于不明原因消化道出血的诊断优于既往常规检查。     

胶囊内镜对隐源性消化道出血的诊断价值

目的研究M2A型胶囊内镜对不明原因的消化道出血病变的检出率及病变类型,评价胶囊内镜在隐源性消化道出血诊断中的应用价值。方法分析18例隐源性消化道出血患者胶囊内镜检查的临床资料。结果18例受检者进行了18次胶囊内镜检查,成功18次,成功率为100%。未见并发症出现。胶囊内镜在胃内平均滞留时间为36min,小肠内滞留时间平均为344min,18例在检查结束后胶囊内镜顺利排出体外。检出16例小肠病变,包括小肠肿瘤,小肠黏膜糜烂,克罗恩病,小肠黏膜血管扩张,空肠活动性出血,小肠静脉瘤。病变检出率为88.9%。结论胶囊内镜检查操作简单,安全,有效,检查成功率高,对不明原因的消化道出血病变的检出阳性率较小肠气钡造影、血管造影为高,且有较高的诊断价值。     

胶囊内镜在诊断老年人不明原因消化道出血的临床应用分析

目的评价胶囊内镜在老年人不明原因消化道出血中的诊断价值。方法对75例不明原因消化道出血老年患者行胶囊内镜检查,总结临床资料,并对此进行统计分析。结果 75例患者顺利完成检查,无感任何不适,其中63例发现小肠病变,阳性检出率为77.3%。结论胶囊内镜应用于老年人小肠病变检查,以其安全,操作简便,影像记录全面、能进行全小肠段检查的优点,成为老年人诊断不明原因消化道出血的重要手段。     

胶囊内镜在诊断老年人不明原因消化道出血的临床应用分析

目的评价胶囊内镜在老年人不明原因消化道出血中的诊断价值。方法对75例不明原因消化道出血老年患者行胶囊内镜检查,总结临床资料,并对此进行统计分析。结果 75例患者顺利完成检查,无感任何不适,其中63例发现小肠病变,阳性检出率为77.3%。结论胶囊内镜应用于老年人小肠病变检查,以其安全,操作简便,影像记录全面、能进行全小肠段检查的优点,成为老年人诊断不明原因消化道出血的重要手段。     

胶囊内镜在不明原因消化道出血中的诊断价值

目的:探讨胶囊内镜在不明原因消化道出血中的诊断价值。方法:对20例不明原因消化道出血患者行胶囊内镜检查的临床资料进行回顾性分析。结果:肠道血管畸形5例,小肠克罗恩病4例,小肠间质瘤4例,小肠溃疡1例,回肠非特异性炎1例,病变检出率为75%(15/20)。部分患者经手术病理证实。结论:胶囊内镜安全、无创,对不明原因消化道出血具有较高的诊断价值,在有条件的医院,可推广应用。     

胶囊内镜在基层医院消化道出血诊断当中的应用价值分析

目的:研究胶囊内镜在基层医院不明消化道出血诊断中的应用价值。方法:将某院收治的33例消化道出血患者作为研究对象,利用胶囊内镜检查方式对所有患者进行诊断,将患者的检查结果和病理证实结果进行对比分析。结果:33例患者中13例正常,小肠粘膜隆起糜烂5例,小肠多发性点状出血4例,食管下段糜烂或溃疡2例,空肠息肉1例,小肠粘膜多发性溃疡或糜烂(考虑克罗恩病)3例,糜烂性胃炎及急性小肠炎症2例,空肠息肉1例,十二指肠球部溃疡2例,胶囊内镜检查结果同病理诊断结果一致率为86.21%。结论:胶囊内镜在基层医院消化道出血临床诊断过程中发挥着重要作用,安全可靠,具有很高的临床诊断价值。     

胶囊内镜诊断不明原因消化道出血52例临床分析

目的探讨胶囊内镜对不明原因消化道出血的诊断价值。方法分析2011年1月至2012年3月间52例不明原因消化道出血患者行胶囊内镜检查的结果。结果 52例患者共检出病变45例,阳性检出率为86.5%。结论胶囊内镜检查安全、无痛苦,对不明原因消化道出血有较高的诊断价值,可作为不明原因消化道出血的首选检查方法。     

胶囊内镜在不明原因消化道出血诊断中的价值

目的探讨国产胶囊内镜在不明原因消化道出血诊断中的价值。方法总结分析46例不明原因消化道出血胶囊内镜检查资料。结果共检出病变39例,包括血管畸形22例,小肠肿瘤5例(间质瘤2例,小肠癌2例,淋巴瘤1例),新鲜出血3例,小肠多发及孤立溃疡3例,小肠钩虫病2例,小肠糜烂2例,Meckel憩室1例,结肠息肉1例。结论国产胶囊内镜对不明原因消化道出血诊断率可达84.8%,安全且易被患者接受,成为了这类疾病的首选方案。     

胶囊内镜联合仿真内窥镜在不明原因消化道出血中的应用

目的探讨胶囊内镜（capsule endoscopy,CE）联合仿真内窥镜（CT virtual endoscopy,CTVE）在不明原因消化道出血（obscure gastrointestinal bleedingOGIB）中的应用价值。方法对21例因不明原因消化道出血的患者同时行CE及CTVE检查分析两者联合在不明原因消化道出血的应用价值。结果共有19例患者发现了病变,其中小肠间质瘤7例,炎症3例,肉芽肿1例,小肠血管畸形1例,转移瘤1例,小肠憩室2例,肠管畸形1例,Dieulafoy溃疡1例,结肠癌1例,钩虫病1例;两者吻合率81．0％。结论cE联合CTVE在不明原因消化道出血中有较高的应用价值。     

Review article: the diagnosis and investigation of obscure gastrointestinal bleeding

Aliment Pharmacol Ther 2011; 34: 416–423

Summary

Background Obscure gastrointestinal bleeding (OGIB) is a commonly encountered clinical problem in gastroenterology and is associated with significant morbidity and mortality. The investigation and management of OGIB has changed dramatically over the past decade with the advent of newer gastroenterological and radiological technologies. Aim To review the current evidence on the diagnosis and investigation of OGIB. Methods We searched the PubMed database (1985–2010) for full original articles in English‐language journals relevant to the investigation of OGIB. The search terms we used were ‘gastrointestinal bleeding’ or ‘gastrointestinal hemorrhage’ or ‘small bowel bleeding’ each in combination with ‘obscure’, or ‘capsule endoscopy’, or ‘enteroscopy’ or ‘enterography’ or ‘enteroclysis’. Results Capsule endoscopy (CE) or double balloon enteroscopy (DBE) should be first line investigations. They are complimentary procedures with comparable high diagnostic yields. DBE is also able to provide therapeutic intervention. Newer technologies such as single balloon and spiral enteroscopy are currently being evaluated. Radiological and nuclear medicine investigations, such as CT enterography and CT enteroclysis, are alternative diagnostic tools when CE or DBE are contraindicated. Repeating the gastroscopy and/or colonoscopy may be considered in selective situations. An algorithm for investigation of obscure bleeding is proposed. Conclusions The development of capsule endoscopy and double balloon enteroscopy has transformed the approach to the evaluation and management of obscure gastrointestinal bleeding over the past decade. Older diagnostic modalities still play a complementary, but increasingly selective role.     

CT小肠成像和胶囊内镜检查在不明原因消化道出血诊断中的临床价值研究

目的 探讨CT小肠成像(CTE)和胶囊内镜(CE)在不明原因消化道出血(OGIB)诊断中的作用及其价值.方法 比较研究CTE和CE在40例OGIB患者中检查结果,并最终应用手术病理结果与之进行对照.结果 CTE的诊断阳性率为45.0％(18/40),而CE的诊断阳性率高达70.0％(28/40),两者结果差异有统计学意义(P<0.05).而CE和CTE两者的联合诊断阳性率高达72.5％(29/40),与单纯进行CE检查相比,其结果差异无统计学意义(P>0.05);而同单纯行CTE检查相比,其结果差异有统计学意义(P<0.05).结论 对OGIB的诊断,单纯行CE检查的诊断阳性率显著高于单纯行CTE检查(P<0.05),两者联合检查的诊断阳性率较CE略有提高,但差异无统计学意义(P>0.05),但鉴于CE和CTE具有互补性,在临床实践中对OGIB同时进行CE和CTE检查是有必要的.     

胶囊内镜在小肠出血病因诊断中的应用

目的评价胶囊内镜对小肠出血病因诊断的价值。方法采用国产OMOM胶囊内镜进行消化道检查分析19例不明原因小肠出血患者。结果19例患者行胶囊内镜检查,其中小肠血管畸形5例、间质瘤3例、克罗恩病2例、憩室2例、息肉1例、淋巴瘤1例。总阳性检出率73.7%。且14例患者均经手术及病理证实,余5例小肠黏膜未发现病变。结论胶囊内镜对小肠出血病因诊断有较高临床价值,且安全、无创。     

胶囊内镜对小肠疾病的诊断价值

目的探讨胶囊内镜对小肠疾病的诊断价值。方法对53例经胃、结肠镜检查未发现病因的腹痛及消化道出血患者应用OMOM胶囊内镜检查,对结果进行分析。结果 53例患者均完成对全小肠的观察,除1例未排出体外,其他胶囊均在2～6 d排出。共检出小肠病变39例(检出率73.58%),其中血管病变10例,结节型病变10例,炎症性病变8例,小肠溃疡6例,克罗恩病3例,淋巴管扩张1例,钩虫病1例。结论胶囊内镜对小肠疾病有较高的诊断价值,且安全性高,耐受性好。     

消化胶囊内镜对不明原因消化道出血的临床分析

目的探讨消化胶囊内镜对不明原因消化道出血的临床诊断价值。方法选择我院2009年12月至2011年12月不明原因消化道出血患者共70例,上述患者均行消化胶囊内镜检查。结果胶囊内镜通过幽门时间为(56.3±4.9)min;胶囊内镜在小肠内检查时间为(294.1±39.4)min;胶囊内镜在体内工作时间为(534.4±40.7)min。本组70例患者中,38例患者检出病变,病变检出率为54.3%。其中13例患者有两种以上病变。结论胶囊内镜能够较好的对不明原因消化道出血相关病因做出诊断,诊断价值高,且安全,患者痛苦少。     

Review article: The advent of capsule endoscopy--a not-so-futuristic approach to obscure gastrointestinal bleeding

Capsule endoscopy is a new, wireless, endoscopic examination of the small intestine. To date, two small clinical trials have been reported utilizing capsule endoscopy in patients with obscure gastrointestinal bleeding, and have shown its superiority to push enteroscopy in diagnosing the cause of blood loss. No outcome studies have been reported. This paper proposes a change in practice guidelines for obscure bleeding. It is our opinion that, in the future, with the advent of wireless capsule endoscopy, the evaluation of patients with obscure gastrointestinal bleeding will be very different from the practice of medicine today. We believe that capsule endoscopy will become the first-line method for the evaluation of patients with obscure bleeding, once upper endoscopy and colonoscopy have been shown to be negative. In patients with active bleeding, capsule endoscopy will confirm the small bowel as the site of bleeding, providing a location, or, if the study is negative for the small intestine, may indicate that the bleeding is either colonic or gastric in origin. In a patient with active bleeding within the small intestine, the capsule will guide further evaluation and therapy. A patient with a small bowel tumour detected by capsule endoscopy will proceed directly to laparoscopic surgery. If the site of bleeding is identified in the proximal small bowel and there is no mass, push enteroscopy will be used to re-identify the site and cauterize it. A distal small bowel site will require surgical intervention, coupled with intra-operative enteroscopy. Should the patient be too sick to undergo surgery, medical therapy utilizing hormonal agents will be considered. A colonic site will be evaluated by colonoscopy. In patients with a more occult or intermittent type of bleeding and in those whose upper endoscopies and colonoscopies are negative, capsule endoscopy will be used similarly to identify a bleeding lesion and thereby direct subsequent testing or treatment.     

Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy

BACKGROUND: The identification and treatment of lesions located in the small intestine in obscure gastrointestinal bleeding is always a clinical challenge. AIM: To examine prospectively the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding. METHODS: Forty-two patients (22 men and 20 women) with obscure gastrointestinal bleeding (overt bleeding in 26 cases and occult blood loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy and colonoscopy were analysed. All patients were instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days. Both techniques were blindly performed by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding. RESULTS: A bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; eight of 42) (P = 0.05). The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal diagnoses were made by enteroscopy. In seven patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach. CONCLUSIONS: Compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.