小肠疾病内镜检查的现状与发展

小肠疾病的临床诊断非常困难,传统的检查方法往往无法明确病因.近年来,小肠内镜检查技术获得突破性进展.该文阐述胶囊内镜和双气囊小肠镜的开发、应用和临床评估,两者联合应用,必要时辅以血管造影等检查,可提高小肠疾病的诊断水平.     

小肠疾病内镜检查的现状与发展

小肠疾病的临床诊断非常困难,传统的检查方法往往无法明确病因。近年来,小肠内镜检查技术获得突破性进展。该文阐述胶囊内镜和双气囊小肠镜的开发、应用和临床评估,两者联合应用,必要时辅以血管造影等检查,可提高小肠疾病的诊断水平。     

双气囊小肠镜在胶囊内镜检查阴性小肠疾病诊断中的作用

目的通过双气囊小肠镜对胶囊内镜检查阴性疾病的诊断,探讨胶囊内镜在不同小肠病变的诊断作用。 方法对156例疑诊为小肠疾病患者行胶囊内镜检查,随后对87例阴性患者进一步行双气囊小肠镜检查。 结果156例患者中69例胶囊内镜检查阳性,其中不明原因消化道出血52例,有警报症状和体征17例,总体阳性诊断率44．2％（69／156）,检出的主要病变有：小肠炎症（粘膜糜烂、溃疡）32例,小肠肿瘤24例,小肠血管发育不良9例,小肠憩室1例,白塞病2例,小肠结核钙化灶1例。87例胶囊内镜检查阴性患者经双气囊小肠镜检查额外检出小肠病变12例,对于胶囊内镜检查阴性患者双气囊小肠镜诊断率为13．8％（12／87）,其中不明原因消化道出血9例,有警报症状和体征3例,检出病变有：小肠憩室5例,小肠血管发育不良4例,小肠溃疡1例,小肠肿瘤2例。 结论胶囊内镜对于表现为隆起性、浸润性、溃疡和多发性病灶小肠疾病具有较高的的诊断能力,但对小肠憩室和病变局限病灶较小的小肠血管发育异常者诊断能力有限,与双气囊小肠镜有效结合运用能大为提高小肠疾病的诊断率和准确性。     

CT小肠成像与双气囊小肠镜在疑似小肠出血诊断中的临床应用

目的 通过对疑似小肠出血患者的临床资料进行回顾性分析,探讨CT小肠成像(CTE)与双气囊小肠镜(DBE)在疑似小肠出血诊断中的应用价值.方法 回顾性分析2019年10月-2020年10月于安徽医科大学第一附属医院消化内科住院的54例疑似小肠出血患者的临床资料,统计CTE及DBE对疑似小肠出血诊断的阳性结果及并发症发生例...     

双气囊内镜在小肠疾病诊疗中的临床应用

小肠是人体重要的消化器官,但由于解剖学的原因,小肠疾病的诊断比较困难.2001年,日本Yamamoto等[1]发明了双气囊小肠镜(double-balloon enteroscopy,DBE),由于其能对深部小肠进行直视检查和组织活检,显著提高了小肠疾病的诊断率;同时,能对一些小肠疾病如出血、息肉、狭窄及异物等进行治疗,现已成为诊治小肠疾病的最重要的检查手段.本文就DBE近几年来的临床应用进展作一介绍.     

老年患者小肠出血病因及相关因素分析

目的:通过分析考虑小肠病变出血的老年患者胶囊内镜检查结果及病史资料,对病因及相关因素进行分析总结。方法:回顾分析2010年12月至2015年2月考虑小肠出血老年患者的胶囊内镜检查结果及相关病历资料。选择检查者年龄均≥60岁,总共83例,其中男性40例,女性43例,平均年龄(67±6)岁。检查前均行胃肠镜检查未发现明显出血病灶。结果 :共有52例患者检出病变,阳性率62.65%。其中小肠黏膜糜烂、出血点25例,小肠肿瘤9例,钩虫病9例,小肠血管畸形8例,缺血性肠病1例。结论 :老年患者不明原因消化道出血病因中,以小肠黏膜多发糜烂、出血点发病率最高,通过病历分析多与服用非甾体类抗炎药相关;其次为小肠肿瘤及小肠血管畸形;在川南地区农村老年患者中,钩虫感染所致消化道出血亦占有较高比重;缺血性小肠病变发病率相对较低。     

小肠深段内镜检查在克罗恩病诊断中的价值

摘要：目的探讨胶囊内镜(CE)、双气囊小肠镜(DBE)进行的小肠深段内镜检查(DSBE)在克罗恩病(CD)诊断中的价值。方
法归纳并分析2004年01月~2008年12月5年间南方医院确诊且接受CE、DBE 检查的54例CD患者的消化道内镜及相
关临床资料。结果患者行DSBE的主要指征为疑似CD(42.6%)及不明原因性消化道出血(25.9%)。小肠深段病变的镜
下形态以非特异性为主,多呈节段性分布。小肠DSBE明显优于钡剂影像检查;DSBE病变检出率(92.6%)高于结肠镜检
查(75.9%, P=0.017),其所提供的CD特征性表现,如节段性肠段分布、肠腔变形,较结肠镜检查明显增加。DSBE能显著
改善患者的诊断情况,但倾向于提供疑似CD的指导性判断。结论DSBE有助于小肠段CD病变的检出及受累范围的评
估,为CD的诊断、鉴别和复查等提供依据和指向;适当选用DSBE并将其结果与常规影像、胃肠镜及临床等资料综合、分
析,将增强DSBE在CD诊治中的作用及有效性。
     

OMOM胶囊内镜、双气囊小肠镜、术中小肠镜检查对小肠出血的临床对比研究

自从胶囊内镜和双气囊小肠镜问世以来使得临床医生对小肠疾病的认识逐渐加深,尤其对未明原因的消化道出血的检出率提高到了50％左右。已经有较多对比研究分析了胶囊内镜与双气囊小肠镜各自的优缺点。但是二者对小肠病变的检出率仍然难以完全达到临床要求,同时对于胶囊内镜、双气囊小肠镜与术中小肠镜缺少对比研究。本研究旨在探讨三者对小肠出血性疾病的诊断价值。     

双气囊小肠镜及CT小肠成像对不同年龄患者小肠疾病的诊断价值

目的 探讨双气囊小肠镜(DBE)及多层螺旋CT小肠成像(MDCTE)在不同年龄患者小肠疾病诊断中的价值及安全性。方法 收集2015年1月~2017年12月武汉大学人民医院疑诊小肠疾病且行DBE及MDCTE的患者病例资料,应用McNemar检验对两种诊断方法在不同年龄患者中的检出率进行比较。结果 本研究纳入106例患者,中老年组(≥45岁)62例,青少年组(＜45岁)44例。中老年患者中,MDCTE及DBE的总检出率分别为46.8%和66.1%,青少年患者中为56.8%及84.1%。在不明原因消化道出血患者中,各年龄组DBE的检出率均高于MDCTE,差异均有统计学意义(P<0.05)。对于慢性腹痛患者,各年龄组DBE检出率高于MDCTE,但差异无统计学意义(P>0.05),因此对主要适应证各年龄段两种检查效能比较,差异无统计学意义。中老年组最常见的小肠疾病依次为血管畸形、肿瘤;青少年组则以炎性疾病居多。DBE对各常见疾病的检出率均高于MDCTE,在炎性疾病(P=0.039)和肿瘤(P=0.039)中比较,差异有统计学意义,对于血管畸形的检出二者比较,差异无统计学意义。结论 MDCTE及DBE均为小肠有效且安全的检查方式,需根据二者优缺点以及不同年龄患者的小肠疾病特点确定诊断方案。对于中老年患者,以血管畸形及肿瘤性病变多见,行MDCTE联合DBE检查可进行较全面的评估;对于青少年患者,根据病情怀疑炎性病变时可直接行DBE检查,必要时行MDCTE检查。     

41例小肠出血病因及诊断分析

<正> 自急诊内镜开展以来,上消化道出血和大肠疾病出血诊断率明显提高,而小肠出血诊断仍较为困难,我院自1985年以来经内镜、影像学检查及手术诊断小肠出血41例。现分析如下。     

The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases

Background The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy （CE） and double-balloon enteroscopy （DBE） are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities. Methods Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE （under anesthesia with propofol） first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed. Results Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carded out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE （72.0%, 118/164） was superior to that with DBE （41.2%, 21/51）; X2=16.1218, P〈0.0001. The diagnostic rate （51.8%, 85/164） was also higher than that with the latter procedure （39.2%, 20/51）, but was not significantly different （X^2=2.4771, P〉0.05）. Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE （88.0%, 88/100） was superior to that of DBE （60.0%, 9/15）; X2=7.7457, P=0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures. Conclusions The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.     

小肠镜在不明原因小肠出血术前定位中的意义

目的 探讨小肠镜对小肠出血手术前定位的临床应用价值。方法 回顾性分析2003年6月～2004年12月小肠镜明确出血部位并行手术治疗的13例患者的临床资料。结果13例患者小肠镜术前的病灶定位与术中发现的病变部位基本一致，但其中3例定性诊断不一致。结论 小肠镜对小肠出血术前定位具有一定的临床价值。     

双气囊小肠镜与小肠钡灌诊断小肠疾病的对照研究

目的 比较双气囊小肠镜和小肠钡灌检查对小肠疾病的诊断价值。方法 2003年3月至2004年9月,43例经多项常规检查阴性、疑为小肠疾病患者分别行双气囊小肠镜和小肠钡灌检查,结合手术和病理所见,对照两者的病因诊断率,就其整体检出率和对小肠基本病变诊断的准确性进行比较。结果 小肠镜发现36例病灶,整体检查阳性率83．7％;小肠钡灌发现22例病变,整体检查阳性率51．2％。小肠镜检出小肠肿瘤13例,炎性、溃疡性病变20例,血管畸形3例;小肠钡灌分别检出7例、15例、0例。结论 在小肠疾病的整体检出率和病因诊断率方面,双气囊小肠镜要优于小肠钡灌。     

Application of double-balloon enteroscopy in the diagnosis and therapy of small intestinal diseases

Background X-ray of the digestive tract and radionuclide examination could not accurately detect diseases of the small intestine. Double-balloon enteroscopy has been used to increase the detection rate of these diseases in addition to endoscopic biopsy and therapy. The purpose of this study was to determine the value of double-balloon enteroscopy in the diagnosis and treatment of diseases of the small intestine. Methods A total of 258 double-balloon enteroscopies via the mouth and/or anus were performed in 208 patients. If no lesion was detected on one side （mouth or anus）, examination on the other side （anus or mouth） was made. If active small intestinal bleeding was detected, endoscopic hemostasis was done to treat the bleeding. Results In the 208 patients, 50 were subjected to double-balloon enteroscopy via both mouth and anus. Lesions were detected in 151 patients, giving a rate of 72.6% （151/208）. The detection rates for obscure digestive tract bleeding, diarrhea, abdominal pain and weight loss were 90.2% （92/102）, 64.9% （24/37）, 48.5% （16/33） and 43.3% （13/30）, respectively. Lesions of the 151 patients were confirmed by endoscopic biopsy, surgery, clinical studies, and follow-up. In the 102 patients with bleeding of the digestive tract, active bleeding was detected in 27 patients. Endoscopic hemostasis was successful in 25 of them （92.6%, 25/27）. No serious complications occurred in all the patients, the average time for the procedure was 100 minutes. Conclusions Double-balloon enteroscopy is safe, effective in the diagnosis of diseases of the small intestine in addition to endoscopic therapy.     

43例小肠出血的病因及诊断分析

目的：探讨小肠出血的病因及诊断方法。：回顾分析1994年1月至1999年12月小肠出血病人43例，经胃镜，结肠镜检查排除十二指肠球部以上消化道和结直肠病变，选择应用小肠钡灌，小肠镜，选择性肠系膜血管选影（DSA），核索扫描（ECT）等检查。结果：43例小肠出血病人，6例结果阴性予以随访，37例检查结果阳性病人予手术探查，病理证实，其中小肠肿瘤20例（54．1％），血管病变6例（16．2％），克隆5例（13．5％），憩室3例（8．1％），炎性肠病3例（8．1％），各检查方法在小肠出血的检查中阳性率分别为：ECT 66．7％，DSA53．0％，DSA53．0％，小肠钡灌45．0％，小肠镜28．5％，结肠镜14．3％，结论：小肠出血临床上常缺乏典型症状，在常规胃镜，结肠镜排除胃十二肠球部以上消化道和结直肠病变后，考虑小肠疾病至消化道出血的可能，缓慢出血者作小肠镜，小肠钡灌检查，ECT，DSA适用于活动出血者或其他检查阴性病人，伴腹块者B超，CT有助于诊断。     

双气囊小肠镜治疗小肠疾病的安全性分析

【摘要】目的：分析双气囊小肠镜治疗小肠疾病的临床效果及安全性。方法：回顾性分析我院2008年2月至2016年3月43例行双气囊小肠镜下治疗的小肠疾病患者的临床资料及随访结果。结果：43例患者中,35例因小肠血管畸形行小肠镜下止血治疗,其中4例予以硬化剂注射及APC治疗,31例予以APC和或电凝治疗;3例因小肠息肉行息肉切除术;5例因小肠异物行内镜下治疗术,其中4例为小肠滞留的胶囊内镜,予以圈套器套取出体外,1例为回肠末端粪石梗阻,予以碎石后取出至结肠,所有内镜下治疗过程均顺利完成,无严重并发症发生。结论：双气囊小肠镜治疗小肠疾病安全有效。     

Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding

Background In obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy. Methods From May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography. Results M2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn’s disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy. Conclusions The present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior to push enteroscopy in detecting GI bleeding (P&lt;0.001). Capsule endoscopy is safe and painless, and should become the initial diagnostic choice for patients with obscure GI bleeding.