胶囊内镜检查不明原因消化道出血126例分析

目的评价胶囊内镜对小肠出血的诊断价值。方法对126例不明原因消化道出血患者行OMOM胶囊内镜检查的结果进行分析。结果126例均成功完成胶囊内镜检查,未发生任何并发症。病变检出率为73．02％（92／126）,病因包括小肠血管发育不良79例（85．87％）,小肠溃疡7例（7．61％）,小肠蛔虫症3例（3．26％）,小肠肿瘤2例（2．17％）,小肠毛细血管扩张1例（1．09％）。结论患者对胶囊内镜耐受性好。胶囊内镜对病变检出率较高,主要病因为血管发育不良,可见胶囊内镜对不明原因消化道出血具有较高的诊断价值。     

Pillcam SB胶囊内镜对小肠疾病的诊断价值

目的探讨Pillcam SB胶囊内镜对小肠疾病的诊断价值。方法选择2012年12月²014年6月期间接受胶囊内镜检查的54例受检者为研究对象(胶囊内镜组)。受检者在胶囊内镜排出体外后,有32例受检者愿意再行全消化道造影检查(传统检查组)。疑诊小肠疾病者46例(疑诊小肠疾病组),无症状人群8例(无症状人群组)。54例受检者中20例检查前一周有肉眼可见的血便(急性显性出血组),14例受检者症状主要为黑便或反复大便潜血阳性(慢性隐性出血组)。统计检查成功率、病变检出率、诊断阳性率等指标。结果胶囊内镜在小肠运行时间为(317.97±18.21)min,工作时间为(494.97±26.19)min。胶囊内镜组检出病变以小肠粘膜多发糜烂、小肠肿瘤、小肠淋巴滤泡增生症为主,两组未见病变分别为14、27例。胶囊内镜组检出率和诊断阳性率均明显高于传统检查组(p<0.01)。疑诊小肠疾病组和无症状人群组两组检查成功率、回盲部通过率、病变检出率比较均无统计学差异(p>0.05)。急性显性出血组和慢性隐形出血组两组检查成功率、回盲部通过率、病变检出率、诊断阳性率比较均无统计学差异(p>0.05)。所有受检者检查中未出现并发症。胶囊滞留率为0%。结论 Pill Cam SB胶囊内镜检查小肠疾病无创、安全性高,具有较高的病变检出率和诊断阳性率,对小肠疾病具有较高的诊断价值。     

小肠疾病的诊断方法选择

小肠疾病包括肿瘤、炎症和出血性疾病三大类。其起病多隐匿,临床上多表现为腹痛、黑便、贫血等,没有特异性,容易漏诊、误诊。因此,对有上述症状的病人在排除胃、十二指肠和大肠疾病后,即应考虑小肠疾病的可能,并进行相关的检查。目前,对于小肠疾病的诊断主要包括影像学方法和内镜学方法。影像学方法包括小肠造影、血管成像等,内镜检查包括胶囊内镜和气囊内镜等。面对诸多     

对我院367例小肠疾病患者应用胶囊内镜诊治的临床疗效分析

目的：对我院收治的367例小肠类疾病患者采用胶囊内镜诊治的临床疗效进行分析与探讨。方法367例小肠疾病患者行胶囊内镜检查,对其检查结果进行分析,并根据手术结果分析胶囊内镜诊断符合率。结果经胶囊内镜检查显示,367例小肠疾病患者中胶囊内镜对不明原因的消化道出血检出率比较高,对炎性改变、疑似恶性肿瘤方面检出率较低,且与手术结果相比较,胶囊内镜符合率分别为血管病变71.4%、隆起性病变55.6%、高度疑似良性肿瘤70%、高度疑似恶性肿瘤71.4%、高度疑似克罗恩氏病100%。结论胶囊内镜对小肠的诊断率较高,在临床中,可作为诊断小肠疾病的有效工具。     

诊断小肠出血有新招

小肠因各种疾病引起的出血虽不如胃、食管、大肠出血常见,但因检查方法的限制,不易作出正确诊断,常常延误病情。目前诊断小肠出血常用的检查方法有:核素显像、腹腔动脉造影(DNA)、气钡造影等,但有一定的局限性。新近由以色列科学家研制的胶囊内镜在小肠出血的诊断中显示出其独特的优点,可谓绽开的“奇葩”。胶囊内镜,又称无线内镜,其外形有如半粒药物胶囊,内装闪光摄像蕊片,每秒钟可拍摄两张照片。吞吸这种特殊“胶囊”之后,它经过咽部、食管,从胃一直到直肠,小肠是必经之地,它不停地拍照,不停地将照片通过无线电波传送给挂在患者腰带上的…     

小肠出血诊断和外科治疗进展

小肠出血病因复杂多样,临床上常表现为呕血、便血、慢性贫血等,临床诊断较为困难,给临床带来极大的挑战.目前小肠出血的诊断方法多样,包括钡剂造影、螺旋CT检查、选择性动脉造影检查、核素扫描等.胶囊内镜检查和双气囊内镜检查实现了全段小肠检查,具有较好的发展前景.腹腔镜检查亦被经常用于小肠出血疾病的诊断和治疗.外科治疗是小肠出血性疾病的重要治疗手段之一,特别是小肠急性大出血.但是外科治疗亦存在其局限性和风险性.现就小肠疾病伴出血的诊断和外科治疗进展作综述,希望对小肠出血的诊断和治疗的临床决策提供帮助.     

胶囊内镜在小肠疾病诊断中的应用及前景

目的探讨胶囊内镜在小肠疾病诊治中的临床应用,并观察患者使用胶囊内镜的安全性及顺应性。方法分析该院91例患者胶囊内镜临床检查资料。结果胶囊内镜通过率为98.91%,小肠疾病检出率60.44%,不明原因消化道出血(OGIB)检出率70.00%。患者顺应性良好,1例出现胶囊滞留,未出现并发症。结论胶囊内镜在小肠疾病中有良好的诊断价值,是一种安全的、首选的检查方法。     

胶囊内镜的临床应用与评价

目的评价胶囊内镜对小肠疾病及其对食管、胃、结肠病变的诊断价值。方法对5例健康体检者，39例疑患小肠疾病的患者进行胶囊内镜检查。结果44例患者进行了45次胶囊内镜检查，1例因胶囊内镜滞留在胃内而进行第二次检查，检查过程中患者无任何不适。胶囊内镜顺利通过回盲辩41例，2例胶囊行至回肠末端，1例胶囊滞留于胃内。全部胶囊在检查结束后．排出体外。检出了15种病变：食道静脉曲张、糜烂性胃炎、胆汁返流性胃炎、胃黄色瘤、十二指肠炎、十二指肠溃疡、小肠肿瘤、小肠血管畸形、克罗恩病、小肠单发及多发息肉、非特异性小肠炎、吸收不良综合征、小肠憩室、结肠黑病变、结肠癌。结论胶囊内镜检查操作简单、安全、有效。对消化道疾病尤其是小肠疾病有较高的诊断价值。     

如何提高消化道出血的诊断水平

消化道出血是临床常见病症，随着内镜技术（主要是电子胃镜和结肠镜）的普及，绝大部分患者的出血原因诊断明确，但是有10％-20％的患者通过胃镜及肠镜检查仍不能明确诊断。目前所谓不明原因的消化道出血（obscure gastrointestinal bleeding，OGIB），主要是小肠源性出血．但也有部分OGIB的患者出血部位是在胃镜和全结肠镜检查能够检查到的部位，由于检查时间滞后，操作技术不当或经验不足，微小病变常被遗漏。胶囊内镜及推进式双气囊小肠镜应用使消化内镜对消化道检查己拓展至深部小肠，     

国产OMOM胶囊内镜在消化道小肠疾病诊疗中的重要性分析

目的?探讨国产OMOM胶囊内镜在消化道小肠疾病诊疗中的重要性.方法?选取我院2010年1月—2012年8月30例接受0MOM胶囊内镜检查的患者,并详细分析患者的临床资料.结果?胶囊内镜通过胃部时间12~130 min,小肠时间192~345 min.胶囊排出体外需18~170 h,平均所需27.2 h,且没有破损.胶囊内镜拍摄图像大部分清晰,少部分受小肠气泡和粪渣感染影响图像质量.消化道阳性检测率76.67%,小肠病变60%.出血组小肠病变77.8%;腹痛组小肠病变66.67%,健康组人员小肠病变33.3%.小肠病变总检出率50%.胶囊嵌顿是胶囊内镜所引发的主要并发症,大部分患者都能够自行排出胶囊,本文有1例没有及时排除.结论?国产OMOM胶囊内镜操作简单、安全有效、无痛苦,对小肠疾病检出率高,尤其适用于不明原因消化道出血的患者.     

Evaluation of diagnostic yield and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding

BACKGROUND AND AIMS: The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months. RESULTS: A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding. CONCLUSIONS: Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.     

Multiple angiodysplasias diagnosed by capsule endoscopy

Angiodysplasias are the most frequent vascular lesions of the gastrointestinal tract and sources of significant mortality from bleeding. Small bowel angiodysplasias account for approximately 40% of cases of gastrointestinal bleeding with obscure origin and represent the single most common cause for hemorrhage in this subset of patients. Their cause is unknown but most are probably acquired and the result of a degenerative process associated with aging. The difficulty of their diagnosis stems from their multiple appearance and small size. Examinations that have been performed so far support that the sensitivity of capsule endoscopy (CE) performed during active bleeding was higher than in case of previous overt bleeding and occult bleeding. Case report: A 61-year-old female patient, who has received anticoagulant therapy for 13 years, presented with recurrent gastrointestinal bleeding of obscure origin underwent wireless capsule endoscopy after negative upper endoscopy and colonoscopy. CE showed non-bleeding typical angiodysplasia in the antrum of the stomach and active bleeding in the first third of jejunum without a visible bleeding source. As the next diagnostic step we performed selective mesenteric angiography to clarify the diagnosis and at the same time we also applied radiological intervention. Conclusion: Capsule endoscopy changed in practice guidelines for obscure bleeding and became the first-line method for evaluation of patient after upper endoscopy and colonoscopy have been shown to be negative. If the examination is performed early, CE could shorten considerably the time to diagnosis, lead to definitive treatment and numerous examinations with low yield could be avoided. The therapy of small bowel angiodysplasias is questionable. Radiological intervention poses the least load for the patient.     

Role of capsule endoscopy in patients with portal hypertension and obscure gastrointestinal bleeding

BACKGROUND AND AIMS: Limited number of data are available on small bowel changes due to portal hypertension. The present retrospective, comparative study was aimed to analyse the diagnostic yield and to describe the findings with capsule endoscopy of cirrhotic patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: Capsule endoscopy findings of 11 cirrhotic patients with portal hypertension and 22 non-cirrhotic patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy were compared. Capsule video recordings were evaluated by two investigators at both workplaces. Patients after capsule endoscopy were followed-up until a mean of 19 (1-42) months. RESULTS: In total 7 men and 5 women were examined at two medical centres in 48 months with a mean age of 66.2 (+/-7.6) years. The average period between the first clinical symptoms and capsule endoscopy was 15.7 (+/-14.9) months. During this period patients were hospitalized in an average of 2.8 (+/-1.3) times and 7.9 examinations were performed per patients prior to capsule endoscopy. A small bowel bleeding source was diagnosed in all 11 patients. Two definitive bleeding sources were observed in 7 patients (63%). Lesions connected to portal hypertension were found in all patients (8 angiodysplasias, 2 portal hypertensive enteropathies and 1 bowel varix). During the follow-up period rebleeding occurred in 27.3% of cirrhotic patients compared with 18.2% rebleeding rate in the control group. CONCLUSION: Capsule endoscopy is a useful method in patients with portal hypertension and obscure gastrointestinal bleeding after negative upper endoscopy and colonoscopy. Multiple angiodysplasias are often diagnosed in the background of small bowel bleedings, and several bleeding sources frequently occur in these patients.     

Identification of a Meckel's diverticulum bleeding by urgent capsule endoscopy

A 10 year-old patient was admitted to our hospital due to severe gastrointestinal bleeding. His symptoms included hematochezia and fainting. Neither emergency upper endoscopy nor colonoscopy had identified the site of bleeding. During the colonoscopy they noticed that fresh blood entered the cecum from the ileum. An urgent capsule endoscopy was performed 8 hours after the patient admission. They placed the capsule with specific endoscopic technique into the proximal duodenum under general anesthesia. During 3,5 hours by the small bowel passage the capsule moved to the ileum and a focal bleeding lesion was detected at this site, suggesting the typical picture of bleeding Meckel's diverticulum. The patient was transfused by 1 unit of blood, with a minimum haemoglobin level 95 g/l. By surgery the ulcerated Meckel's diverticulum was identified and resected. Histopathology showed ectopic gastric mucosa. Surgical resection of the diverticulum resulted complete healing of this patient. The capsule endoscopy diagnosis was prompt, precise, and the all examinations were carried out within 24 hours. Involving urgent small bowel capsule endoscopy into the diagnostic workup of the obscure bleeding patient could considerably shorten the time to achieve a correct diagnosis and allowed the early institution of definitive treatment. By this one could spare a great number of costly alternative investigations with low diagnostic yield.     

Small bowel stromal tumors diagnosed by capsule endoscopy

Small intestinal stromal tumors account for approximately 35% of all gastrointestinal stromal tumors. Gastrointestinal bleeding is considered as one of the main clinical symptoms for SISTs. Capsule endoscopy has brought revolution in small bowel diagnostics, as it is considered the best method of visualisation of the entire small intestine. Besides, it is well tolerated by patients and is accompanied by a low number of complications. It is also indicated as the first diagnostic method in gastrointestinal bleeding of obscure origin, following negative upper endoscopy and colonoscopy. CASE REPORT: 2 patients (a male and a female, aged 58 and 69, respectively) presented with obscure gastrointestinal bleeding have been examined by capsule endoscopy after negative upper endoscopy and colonoscopy. Videorecords have been assessed in both cases by two independent experts. The capsule reached the Bauchin-valve in both cases during the 8 hours of the testing time and the entire small bowel was clearly visible. - Based on the capsule endoscopic images, for one of the two cases a tumor has been reported as the background of the small intestinal bleeding. In the other case we could mark the location of the bleeding, while we were unable to ascertain the type of the actively bleeding lesion during the test. In order to determine the accurate bleeding source double-balloon enteroscopy was performed in the second case. After surgery the histological and immunohistochemical tests have justified the presence of spindle cell GISTs. Taking into consideration the Fletcher-classification, for the tumor size and the mitotic index, both cases can be classified as a GIST of low malignant potential. CONCLUSIONS: An early diagnosis and application of a definitive therapy become possible by using capsule endoscopy, therefore the chance of survival of the patients might be increased.     

Wireless capsule endoscopy and its role in gastroenterology: our results and a review of the literature

INTRODUCTION: Since its recent introduction, capsule endoscopy has revolutionized the diagnostics of diseases of the small bowel. The number of studies on the use of this method is constantly increasing. Along with this, our knowledge about the usability and diagnostic power of capsule endoscopy is growing and the indications for this technique are getting progressively more accurate. AIMS: To study the usability of capsule endoscopy in suspected Crohn's disease, in gastrointestinal bleeding of small bowel origin, and in undetermined abdominal complains. METHOD: Capsule endoscopy was performed in 20, previously examined, carefully selected patients. RESULTS: Positive findings were recorded in all patients with gastrointestinal bleeding and in 3/4 of patients with suspected Crohn's disease. However, in patients with indeterminate abdominal complains, the capsule endoscopy proved to be inefficient. CONCLUSION: In the study below, based on their own experience, the authors try to provide an overall picture of capsule endoscopy by reviewing contemporary medical literature. The usability of the capsule endoscopy in suspected Crohn's disease and gastrointestinal bleeding of small bowel origin is suggested by the results of the study.     

Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease: an initial experience from 25 examinations

Until recently, only the proximal small bowel was accessible for diagnostic and therapeutic endoscopy. Endoscopic evaluation of this organ has often required open laparotomy with surgically assisted passage of the endoscope through the intestine. Recently, Yamamoto et al have developed a new method, double-balloon endoscopy (DBE) that allows high-resolution visualization and therapeutic interventions in all segments of the GI tract. Our aim was to report our early experience with the Fujinon EN-450 T5 therapeutic double-balloon endoscope. PATIENTS AND METHODS: Between August 2005 and March 2006, 25 DBE was conducted in 23 consecutive patients (M/F: 13/10, age: 51.8 +/- 16.5 years) presenting at our tertiary referral hospitals (17 and 4 patients from the oral or the anal route, respectively; 2 patients from both). All procedures were done by i.v. anesthesia, at our outpatient clinic. After the procedure, the patients were monitored in a recovery room for at least 4h before discharge. RESULTS: The main indication for DBE was suspected small-bowel GI bleeding (11), diagnosis or complications of IBD (7), polyposis syndrome (3), stenosis (1) and insertion of jejunal catheter in one case. Twelve out of 22 patients (54.5%) had a small-bowel finding, with 16 of 22 (72.7%) of the patients having a more accurate diagnostic input. The average insertion length was app. 165 cm (range 50-350 cm, SD 97). Patients' tolerance of the procedure was excellent. No severe complications were recognized. CONCLUSIONS: Based on our limited experience double-balloon enteroscopy is a safe and useful method to evaluate and treating small bowel disease in selected patients, including patients with suspected small-bowel strictures, in whom capsule endoscopy is contraindicated.     

The role of capsule endoscopy in the diagnosis of small bowel Crohn's disease

Historically, there have been several modalities available for diagnosing small bowel diseases, but - until recently - endoscopic examination of this part of the gastrointestinal tract was not possible. With its direct visualization of bowel mucosa, the 2002 premier of capsule endoscopy was a major break-through in gastroenterology. The most important indication of small bowel capsule endoscopy is Crohn's disease, it provides valuable diagnostic information in patients with suspected, proven and post-operative disease, too. Several clinical studies proved CE's superiority over other methods. Although young age was a contraindication initially, numerous studies have proved its safety and efficacy in pediatric patients. Complications of CE are rare, the main risk is capsule retention and consequent small bowel ileus which can be prevented by a previous trial examination with a digestible, biodegradable patency test-capsule.     

Screening and surveillance for hereditary polyposis and non-polyposis syndromes with capsule endoscopy

The hereditary polyposis syndromes and non-polyposis colorectal carcinoma have been considered as scarcely occurring but inheritable dominant autosomal syndromes. The increasing risk of small bowel carcinoma and prevention of obstruction and intussusception have been making frequent and acute surgical interventions unavoidably led to the necessity of screening and surveillance the patients. Earlier the diagnosis of these symptoms was difficult to establish because traditional radiological methods have a low yield for small polyps. Furthermore, small bowel is only partially accessible with traditional endoscopic techniques such as upper endoscopy, colonoscopy and push-enteroscopy. The "wireless" capsule endoscopy has opened the way then for the non-invasive and painless test of the entire small intestine. - Test results have been cumulated to justify the efficiency and safety of capsule endoscopy concerning the syndromes above. This method can be applied safely even consequently to repeatedly performed surgical interventions by low risk of capsule retention. As the results compared of the diagnosed familial adenomatous polyposis and of Peutz-Jeghers syndrome reflect on capsule endoscopy, its diagnostic sensitiveness is stated as significantly higher than the Barium-contrast X-Ray and MR-enterography. Nevertheless, determination of size and location of polyps has become more problematic when evaluating the test results.