上消化道胶囊内镜发展与创新北大核心CSCD

上消化道疾病高发,传统插管式胃镜是检查上消化道疾病最常用的检查方法和"金标准"。为了更舒适无创的检查上消化道黏膜,多项研究提出了上消化道胶囊内镜的概念,但是由于上消化道各部位解剖与生理结构的差异,目前可以使用的胶囊内镜如单纯被动式、磁控式、线控式、磁控联合线控式以及侧视胶囊内镜都存在一定的局限性,无法实现对上消化道整体黏膜情况的观察。文章试图通过介绍适用于食管、胃以及十二指肠检测的胶囊内镜,分析各内镜的诊断效能及其不足,探讨未来上消化道胶囊内镜可能的发展方向。     

上消化道胶囊内镜现状及研究进展

胶囊内镜是一种安全、无创、人群接受度高的消化道疾病诊断系统,目前已广泛用于小肠疾病的诊断.由于食管通过速度快,胃腔空间大,导致胶囊内镜在上消化道中的应用面临巨大挑战.目前随着磁导航技术、系线胶囊技术等工程技术的发展,胶囊内镜逐步拓展了在上消化道疾病诊断中的应用.有多款上消化道胶囊内镜已应用于临床,同时有更多的胶囊内镜新兴技术正处于研发阶段,为改善胶囊内镜在上消化道疾病诊断中的作用提供了新的希望,本文就用于上消化道的胶囊内镜现状及研究进展做一综述.     

功能性胶囊内镜的研究进展与展望北大核心CSCD

功能性胶囊(functional capsule endoscopy,FCE)是由无线胶囊内镜(wireless capsule endoscopy,WCE)迅速发展而派生出的具有视频功能之外其他功能的无线胶囊系统。由于WCE的尺寸优势和光电技术的进一步发展,人们将更多功能整合在了WCE上。FCE不仅在诊断方面帮助WCE实现了与传统内镜下相似的活检、超声探测等诊断功能,甚至能够进行止血、减肥、灭菌、促排便、靶向给药等多种治疗,是新时代医工结合的重要产物。文章叙述了FCE近十余年的创新发展及临床现状,并归纳其发展趋势。     

胶囊内镜图像阅片质量和效率研究进展北大核心CSCD

胶囊内镜(capsule endoscopy,CE)因无痛无创、非侵入的特点受到患者和临床医生的广泛青睐,检查适应证在各项临床研究中不断得以完善,作为消化道系统无创性诊断的一种革命性的技术创新,现已广泛应用于临床。虽然CE具有方便、快捷、舒适等优势,但检查过程中产生的大量图片给对临床医生带来较大的阅片压力,快速且可靠地阅片成为临床医师的挑战。如何高效准确地进行胶囊内镜图像阅片,成为目前研究的热点和难点问题。     

胶囊内镜临床应用规范研究与展望北大核心CSCD

胶囊内镜(capsule endoscopy,CE)因其使用方便、耐受性好、并发症少及对消化道的可视化程度高,是受患者普遍接受的胃肠道体检方案,已经成为了小肠内镜检查的一线检查方式。但是,胶囊内镜的临床应用仍需进一步规范。文章拟通过归纳美国胃肠内镜学会(ASGE)、欧洲胃肠内镜学会(ESGE)、中华消化内镜学会等多份指南对胶囊内镜操作、报告、培训的要求,总结胶囊内镜的规范化操作流程,归纳其在COVID-19流行背景下的应用情景,探讨胶囊内镜临床实践中所面临的问题,以及胶囊内镜教学未来可能的发展方向。     

胶囊内镜20年发展与展望北大核心CSCD

胶囊内镜的问世攻克了小肠作为内镜检查"盲区"这一的难题,弥补了传统消化内镜的不足。经过20年的探索,胶囊内镜的性能不断提升,实现了适应证的拓展;食管胶囊内镜、结肠胶囊内镜以及胃胶囊内镜的相继推出,实现了全消化道黏膜的可视化;振动胶囊等功能胶囊内镜的研发,实现了从诊断到治疗的初探。     

结肠胶囊内镜探索与展望北大核心CSCD

结肠胶囊内镜(colon capsule endoscopy,CCE)是胶囊内镜家族的新成员,它的出现将推动全消化道胶囊检查的实现。经过不断的探索,两代CCE在电池续航能力、自主控制及精准定位等技术上有所改进,在筛查结肠癌、监测炎症性肠病方面拥有了更高的灵敏度和特异度。文章就CCE的发展历程、应用现状进行总结,以期让读者了解其临床操作流程及适用人群,并对其面临主要难题以及发展方向进行探讨。     

胶囊内镜检查后上消化道大出血1例报道

46岁男性患者接受胶囊内镜检查后发生上消化道大出血，胃镜检查提示贲门黏膜撕裂，给予抗休克和三腔双囊管压迫等治疗措施后出血停止。胶囊内镜在胃内滞留诱发患者呕吐，剧烈的呕吐导致贲门黏膜撕裂引发上消化道大出血。因此对于胶囊内镜滞留胃内的患者要警惕出血的可能。     

胶囊内镜诊断小肠蛔虫感染16例报告北大核心CSCD

回顾性分析四川大学华西医院2006年6月至2012年6月共16例经胶囊内镜确诊的成人小肠蛔虫病患者的临床资料和胶囊内镜图像。16例粪检均未查见虫卵,其中消化道出血15例,贫血15例(重度3例、中度10例和轻度2例),低白蛋白血症2例,外周血嗜酸粒细胞增高1例,粪隐血阳性16例。经胶囊内镜检查均为蛔虫感染,其中14例虫体位于上段小肠,2例位于下段小肠。3例观察到虫体周围小肠黏膜充血红斑和糜烂灶,7例观察到小肠腔内有活动性渗血或陈旧性出血。     

胶囊内镜常见临床不良事件及预防研究北大核心CSCD

胶囊内镜(capsule endoscopy,CE)在20年的发展中因其能够无创检查消化道而在全球得以广泛运用。但在临床应用中CE仍有不良事件的发生,包括CE滞留、检查不全、吞咽困难及误吸,值得我们高度重视。CE滞留因其存在肠梗阻、肠穿孔的风险而备受关注,克罗恩病是CE滞留最主要的原因,可通过探路胶囊评估滞留高危患者肠道的通畅性而避免CE滞留的发生。食管检查不全可通过提升CE拍摄频率和系线牵拉对抗重力提高检查完成率;胃腔检查通过磁场操控CE运动以及提升胃清洁度,提高胃检查完成率;小肠和结肠检查不全是由于电池续航时间有限,可通过延长续航时间及减少胃通过时间等方式促进检查的完成。小儿吞咽困难发生率较高,需要内镜辅助递送CE至胃十二指肠中。CE误吸极为罕见,多见于高龄患者,绝大多数可通过咳嗽自行排出。充分掌握CE不良事件的危险因素及规避措施对于推广CE的临床应用具有极高的价值。     

Are repeat upper gastrointestinal endoscopy and colonoscopy necessary within six months of capsule endoscopy in patients with obscure gastrointestinal bleeding?

Background and Aim: Medicare reimbursement for capsule endoscopy for the investigation of obscure gastrointestinal bleeding in Australia requires endoscopy and colonoscopy to have been performed within 6 months. This study aims to determine the diagnostic yield of repeating these procedures when they had been non‐diagnostic more than 6 months earlier. Methods: Of 198 consecutive patients who were referred for the investigation of obscure gastrointestinal bleeding, 50 underwent repeat endoscopy and colonoscopy solely to enable reimbursement (35 females and 15 males; mean age 59.4 [range: 21–82] years). The average duration of obscure bleeding was 50.16 (range: 9–214) months. The mean number of prior endoscopies was 3 (median: 2) and 2.8 colonoscopies (median: 2). The most recent endoscopy had been performed 18.9 (median: 14; range: 7–56) months, and for colonoscopy, 19.1 (median 14; range 8‐51) months earlier. Results: A probable cause of bleeding was found at endoscopy in two patients: gastric antral vascular ectasia (1) and benign gastric ulcer (1). Colonoscopy did not reveal a source of bleeding in any patient. Capsule endoscopy was performed in 47 patients. Twenty four (51%) had a probable bleeding source identified, and another five (11%) a possible source. These included angioectasia (17 patients), mass lesion (2), non‐steroidal anti‐inflammatory drug enteropathy (2), Cameron's erosions (2), and Crohn's disease (1). Four patients undergoing repeat capsule endoscopy had a probable bleeding source detected. Conclusion: The yield of repeat endoscopy and colonoscopy immediately prior to capsule endoscopy is low when these procedures have previously been non‐diagnostic. Such an approach is also not cost‐effective.     

Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding

Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.     

Initial experience of real-time capsule endoscopy in monitoring progress of the videocapsule through the upper GI tract

BACKGROUND: Wireless capsule endoscopy (WCE) is one of the most important investigations for small bowel examination. Although newer-generation WCE is equipped with a real-time viewer, the role of this advancement in daily practice remains unknown. OBJECTIVE: Our purpose was to determine the role of the real-time viewer for monitoring of the videoendoscope passage through the upper GI tract. DESIGN: Case-control comparison. SETTING: Single tertiary referral center. PATIENTS: Forty-five consecutive patients who underwent capsule endoscopy in a 12-month period were studied. Twenty-seven patients received conventional WCE, whereas 18 patients were examined by real-time WCE. Passage into the small bowel was monitored with the real-time viewer in the second group of patients. Gastric transit time and the rate of complete small bowel examination were compared. INTERVENTIONS: On-demand polyethylene glycol and erythromycin were prescribed according to the progress as viewed by the real-time monitor. MAIN OUTCOME MEASUREMENTS: Small bowel examination completion rate and gastric transit time. RESULTS: Small bowel examination was completed in 19 (70.4%) and 17 (94.4%) patients undergoing conventional and real-time WCE, respectively (P = .048). With the real-time monitoring and on-demand preparations, gastric passage time was significantly reduced (100 vs 59 minutes, P = .02). LIMITATIONS: Nonrandomized study. CONCLUSIONS: The use of the real-time viewer may help to secure the passage of the capsule endoscope into the small bowel and hence result in a higher rate of complete small bowel examination.     

胶囊内镜在不明原因消化道出血中的临床应用

目的探讨胶囊内镜在不明原因消化道出血中的诊断价值、耐受性、并发症。方法对20例不明原因消化道出血患者行OMOM胶囊内镜检查。结果15例胶囊内镜下发现异常,12例明确为出血病灶,诊断率为60%（12/20）,包括克罗恩病5例,间质瘤4例,晚期肿瘤1例,新鲜出血1例,血管瘤1例。20例受检者均耐受良好,2例出现了胶囊滞留。结论胶囊内镜对不明原因消化道出血有较高的诊断率,易耐受,胶囊滞留是其主要并发症,易发生于克罗恩病患者。     

国产胶囊内镜对不明原因消化道出血的诊断价值

[目的]探讨国产OMOM型智能胶囊(OMOM)在不明原因消化道出血(OGIB)患者中的诊断价值。[方法]对36例OGIB患者进行OMOM检查,总结并分析其临床资料。[结果]36例均完成检查,其中25例发现病变,阳性检出率69.4%;≥60岁患者以小肠血管畸形为主。检查过程中无任何不适及并发症。[结论]OMOM对OGIB诊断具有较高的诊断率及准确性,临床安全性好。     

应用胶囊内镜诊断不明原因消化道出血的临床价值探讨

[目的]探讨胶囊内镜(CE)对不明原因消化道出血(OGIB)的诊断价值。[方法]106例OGIB患者依据不同的临床表现分为隐性出血组和显性出血组,均采用CE检查,对诊断结果进行分析总结。[结果]106例OGIB患者中74例获阳性诊断(69.8%),显性出血组占50例(69.5%),隐性出血组占24例(70.6%),2组阳性诊断率比较,差异无统计学意义;阳性诊断结果中以血管病变居多,其次为小肠恶性肿瘤。[结论]CE检查诊断OGIB的价值较高,是一种安全、简便的诊断方法。     

Initial management of nonvariceal upper gastrointestinal bleeding and timing of endoscopy

Acute nonvariceal upper gastrointestinal bleeding is a common cause of hospital admission with significant associated health care expenditures and a significant but improving mortality rate. Initial management includes proper resuscitation with close hemodynamic monitoring, a blood transfusion threshold of 7 g/dL in most patients, early risk stratification using validated prognostic scores, and timely upper endoscopy. Current guidelines recommend that upper endoscopy be performed within 24 hours of presentation, except for patients at very low risk of adverse outcomes who may undergo more elective upper endoscopy. The role of urgent endoscopy for patients at higher risk for adverse outcomes remains controversial.     

Best candidates for capsule endoscopy for obscure gastrointestinal bleeding

Background and Aim: Capsule endoscopy (CE) has an important role in the diagnosis of patients with obscure gastrointestinal bleeding. However, there was still controversy regarding the best candidates for CE. The present retrospective study aimed to access the best candidates for CE. Methods: There were 91 consecutive patients referred to the present study for 94 CE examinations from May 2002 to January 2005. They were divided into two groups (41 with active bleeding, and 50 with previous bleeding). Results: The CE findings were positive in 74.7%, suspicious in 11% of cases and negative in 14.3% of cases, respectively. The positive and suspected positive yield of CE were 75.6% and 19.5% in the active bleeding group, 74% and 4% in the previous bleeding group (P = 0.01), 75.7% and 21.6% in the overt bleeding group, 75% and 0% in the occult bleeding group (P = 0.206), 89.7% and 3.4% in patients who bled 2 weeks previously, 52.38% and 4.76% in patients who bled >2 weeks previously (P = 0.003), 75.6% and 19.5% in active bleeding group, 89.7% and 3.4% in patients who bled 2 weeks ago (P = 0.128). Conclusions: The best candidates for the procedure are those with active bleeding, or active bleeding in the previous 2 weeks.