双气囊小肠镜与胶囊内镜对不明原因消化道出血诊断价值的研究

目的 比较双气囊小肠镜与胶囊内镜对不明原因消化道出血检出率、诊断率和实用价值.方法 对2006年10月至2007年10月第三军医大学新桥医院收治的不明原因消化道出血73例患者行双气囊小肠镜检查,经口腔或肛门进镜检查未发现病灶者,改换进镜方式再行检查.另66例行胶囊内镜检查.对比两种检查方式的临床效果.结果 双气囊小肠镜组检出率为94.5%,诊断率为80.8%;胶囊内镜组检出率81.8%、诊断率为50.0%.两组患者均能耐受检查.结论 双气囊小肠镜组的检出率及诊断率均显著高于胶囊内镜组.而胶囊内镜检查更为简便易行.     

双气囊小肠镜与胶囊内镜诊断小肠出血病因比较

目的比较双气囊小肠镜和胶囊内镜在小肠出血中的诊断准确率和实用价值。方法24例原因不明的可疑小肠出血患者分别接受双气囊小肠镜和胶囊内镜检查。双气囊小肠镜首选进镜方式分为经口或经肛2种，首选方式检查后未发现病灶者，日后改换进镜方式再行检查。胶囊内镜采用以色列GIVEN公司产品。2种检查方法分别由专门医师独立操作并诊断，最后进行汇总比较。结果24例患者中21例通过小肠镜检查发现病灶，总检出率为87．5％。24例患者行胶囊内镜检查后，有阳性发现者11例(45．8％)，另13例无异常发现。双气囊小肠镜检查发现的阳性病灶均经活检病理和手术探查证实，其病因诊断准确率为87．5％，胶囊内镜诊断准确率为25％。在耐受性评估方面，胶囊内镜和全麻下经口进镜的耐受性最佳，以后依次为非麻醉经肛方式和非麻醉经口方式。所有小肠镜和胶囊内镜检查者中未见操作相关的严重不良反应。结论①经口和经肛方式结合能使双气囊小肠镜完成对全小肠的检查。②双气囊小肠镜在不明原因小肠出血的病因诊断方面明显优于胶囊内镜检查。③胶囊内镜在小肠多节段病变和长段病变的诊断上仍有一定价值。④胶囊内镜和全麻下经口双气囊小肠镜检查是一项易为患者接受的、安全的检查方法。     

双气囊小肠镜与胶囊内镜在小肠出血应用中的对比研究

目的比较双气囊小肠镜与胶囊内镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,初步探讨双气囊小肠镜对小肠出血的内镜下治疗。方法2006年4月至2009年10月烟台毓璜顶医院消化内科收治的可疑小肠出血患者159例,其中81例患者行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查。对活动性出血病灶行内镜下止血治疗。另78例患者行胶囊内镜检查。两组患者分别由专门医师独立操作并诊断,最后进行汇总分析,对比双气囊小肠镜与胶囊内镜的临床应用价值。结果双气囊小肠镜组的病变检出率为95.06%,病因诊断率为82.72%,23例检查时见病变活动性出血,行内镜下止血治疗,21例止血成功,内镜止血成功率为91.30%;胶囊内镜组的病变检出率82.05%,病因诊断率为66.67%。双气囊小肠镜组的病因检出率及病因诊断率均显著高于胶囊内镜组,差异有统计学意义(P0.05)。在耐受性方面,胶囊内镜的耐受性最好,双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜。所有患者均未发生严重并发症。结论双气囊小肠镜对小肠出血的病因诊断明显优于胶囊内镜,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法。     

双气囊内镜对小肠疾病的诊断价值

目的 评价双气囊内镜对小肠疾病的诊断价值.方法 45例经B超、CT、胃镜、肠镜等常规检查不能明确病因的患者接受双气囊内镜检查,这些患者中腹痛10例,腹泻8例,不明原因消化道出血19例,腹痛伴黑便3例,腹痛伴腹泻5例.评价双气囊内镜检查的病变检出率、并发症及患者的耐受性等.结果 45例患者经口进镜3例,经肛进镜5例,经口+经肛检查37例.45例患者中34例发现阳性病灶,总体病因确诊率75.6%;不明原因消化道出血病因确诊率73.4%,腹痛、腹泻的病因确诊率分别为70%和62.5%,3例腹痛伴有黑便者及5例腹痛伴有腹泻者均获得病因学诊断,未见操作相关的严重不良反应和并发症.结论 双气囊内镜是一种对小肠疾病诊断价值较高、安全可靠的检查手段.     

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。     

Comparative study of double-balloon enteroscopy and capsule endoscopy in diagnosis of small intestinal bleeding

目的 比较双气囊小肠镜(DBE)与胶囊内镜(CE)对小肠出血性病变检出率、病因诊断率和临床应用的价值.方法 收集我院2007年10月～ 2010年10月收治的可疑小肠出血患者138例,其中行双气囊小肠镜检查74例,另行胶囊内镜检查64例.2种检查方法分别由专门医师单独操作、诊断,最后进行综合比较.结果 双气囊小肠镜对小肠出血性病变检出率(91.89％)和病因诊断率(81.08％)均显著高于胶囊内镜(分别为79.69％,64.06％),两组比较差异均有统计学意义(P＜0.05).结论 双气囊小肠镜对可疑小肠出血的病因诊断率明显优于胶囊内镜,具有较好的临床应用价值.     

双气囊小肠镜在原因不明的慢性腹痛诊断中的价值

目的比较双气囊小肠镜和胶囊内镜对原因不明的慢性腹痛患者的病变检出情况,评价双气囊小肠镜对原因不明的慢性腹痛的诊断价值,探讨小肠疾病导致慢性腹痛的常见病因。方法将46例经胃镜、结肠镜、钡餐等检查结果阴性的慢性腹痛患者行双气囊小肠镜检查,首选进镜方式为经口和经肛2种,首选方式检查后未发现病灶者,改换进镜方式再行检查。另70例患者行胶囊内镜检查。两组患者的相关检查分别由专门医师独立操作并诊断,最后进行汇总分析。结果双气囊小肠镜组46例患者中,15例经口进镜,22例经肛门进镜,9例行口-肛门进镜。通过双气囊小肠镜检查发现病灶28例,小肠病变检出率60.87%;胶囊内镜组70例患者中,29例发现小肠病变,小肠病变检出率为41.43%;双气囊小肠镜的病变检出率明显高于胶囊内镜,差异有统计学意义（P〈0.05）。双气囊小肠镜组和胶囊内镜组检出病变中,以克罗恩病最为常见（分别为9例和8例）,其次为非特异性肠炎。结合小肠镜检查结果、手术及临床上药物治疗效果,双气囊小肠镜组诊断疾病的准确率为82.14%（23/28）。其中除1例患者发生急性胰腺炎外,其余患者均未见严重的不良反应及出血、穿孔等严重的并发症。结论双气囊小肠镜对小肠病变所致的慢性腹痛阳性病变检出率高于胶囊内镜,诊断准确率较高,是一种安全可靠的检查手段;导致慢性腹痛的小肠疾病最常见病因为克罗恩病,其次为非特异性肠炎。     

双气囊小肠镜对小肠出血的诊断价值研究

目的通过双气囊小肠镜对不明原因的小肠出血疾病进行病因分析。方法回顾性分析2008年10月至2014年1月我院应用双气囊小肠镜对小肠出血疾病患者进行检查,并分析消化道出血的病因组成。结果 163名患者接受173例次小肠镜检查,经口进镜检查59例次,经肛门进镜检查104例次,经口及经肛门两端进镜检查10例,检查成功率100%,其中阳性病例134例(77.46%),所有患者未发生出血、穿孔、梗阻等不良反应和相关并发症。结论小肠出血的病因诊断较困难,目前双气囊小肠镜是诊断小肠出血有价值、安全可靠的检查方法。     

胶囊内镜与双气囊内镜诊断小肠疾病的比较

目的比较胶囊内镜和双气囊内镜对小肠疾病的检出率和诊断准确性，探讨其联合应用的临床意义。方法对116例不明原因消化道出血和102例不明原因腹痛或腹泻患者，共218例进行内镜检查。其中165例首选胶囊内镜，53例首选双气囊内镜。对胶囊内镜检查阴性或可疑病变者建议双气囊内镜检查，反之亦然。比较两种检查方法对小肠疾病的检出率、诊断率以及患者依从性、不良反应发生率等。结果1例胶囊内镜和2例双气囊内镜操作失败。51例患者行64次双气囊内镜检查，其中34例经口、4例经肛检查，13例分别接受经口和经肛检查。胶囊内镜对小肠病变的总检出率及对不明原因消化道出血的小肠疾病检出率（72．0％和88．0％），均明显高于双气囊内镜（41．2％和60．0％），诊断率也高于后者（51．8％和39．2％）。5例胶囊内镜检查阴性再经双气囊内镜检查者中，1例发现病灶；15例胶囊内镜检查怀疑小肠病变者中，12例经双气囊内镜结合活检病理确诊。而3例双气囊内镜未发现异常者再经胶囊内镜检查发现小肠病变。所有患者均未发生严重不良反应。结论胶囊内镜对小肠疾病检出率高，可作为怀疑小肠疾病，尤其是不明原因消化道出血的首选检查方法；双气囊内镜在胶囊内镜检查阴性者中仍可发现部分病灶，并能明确多数胶囊内镜下可疑病变，可作为胶囊内镜检查后的补充检测手段。     

胶囊内镜与推进式小肠镜诊断不明原因消化道出血的评价

目的 比较胶囊内镜与推进式小肠镜对不明原因消化道出血的诊断价值。方法 总结32例消化道出血患者的胶囊内镜检查结果及36例消化道出血患者推进式小肠镜检查结果，上述患者均经结肠镜、胃镜、X线钡餐、小肠钡剂灌肠、血管造影或核素扫描等检查未发现异常。结果 胶囊内镜检查的32例中共发现异常26例，检出率为8l％。其中能明确解释出血原因者2l例，包括消化道血管病变8例，小肠炎症性肠病5例，小肠息肉4例，小肠恶性间质肿瘤2例，小肠类癌l例(该患者同时伴升结肠脂肪瘤)及出血性胃炎l例；疑诊5例。推进式小肠镜检查的36例明确出血原因9例，即诊断率为25％，包括空肠上段血管畸形2例，平滑肌肉瘤2例，平滑肌瘤、腺瘤性息肉、克罗恩病、壶腹部腺癌及淋巴瘤各l例；疑诊2例。结论 胶囊内镜对不明原因消化道出血具有较高的检出率和诊断率，检查效果及方法明显优于推进式小肠镜。胶囊内镜可明显简化不明原因消化道出血患者的检查步骤．应成为经胃镜、结肠镜检查阴性患者的首选检查方法。     

Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis

Background and Aim: Uncertainty remains about the best test to evaluate patients with obscure gastrointestinal bleeding (OGIB). Previous meta‐analyses demonstrated similar diagnostic yields with capsule endoscopy (CE) and double balloon enteroscopy (DBE) but relied primarily on data from abstracts and were not limited to bleeding patients. Many studies have since been published. Therefore, we performed a new meta‐analysis comparing CE and DBE focused specifically on OGIB. Methods: A comprehensive literature search was performed of comparative studies using both CE and DBE in patients with OGIB. Data were extracted and analyzed to determine the weighted pooled diagnostic yields of each method and the odds ratio for the successful localization of a bleeding source. Results: Ten eligible studies were identified. The pooled diagnostic yield for CE was 62% (95% confidence interval [CI] 47.3–76.1) and for DBE was 56% (95% CI 48.9–62.1), with an odds ratio for CE compared with DBE of 1.39 (95% CI 0.88–2.20; P = 0.16). Subgroup analysis demonstrated the yield for DBE performed after a previously positive CE was 75.0% (95% CI 60.1–90.0), with the odds ratio for successful diagnosis with DBE after a positive CE compared with DBE in all patients of 1.79 (95% CI 1.09–2.96; P = 0.02). In contrast, the yield for DBE after a previously negative CE was only 27.5% (95% CI 16.7–37.8). Conclusions: Capsule endoscopy and double balloon enteroscopy provide similar diagnostic yields in patients with OGIB. However, the diagnostic yield of DBE is significantly higher when performed in patients with a positive CE.     

胶囊内镜序贯联合双气囊小肠镜诊断小肠出血

目的评价胶囊内镜(capsule endoscopy,CE)序贯联合双气囊小肠镜(double-balloon enteroscopy,DBE)检查对小肠出血疾病(small intestine bleeding,SIB)的临床诊断价值。方法回顾性分析106例行CE检查及部分序贯联合DBE检查SIB患者的临床资料。结果 106例SIB患者病因明确诊断率为96.2%(102/106),以肠黏膜糜烂、溃疡性病变25.5%(27/106)、血管病变24.5%(26/106)、小肠肿瘤、隆起病变23.6%(25/106)最常见;行CE和DBE检查的病变检出率分别为89.6%(95/106)、96.2%(50/52),病因诊断率分别为50.9%(54/106)、92.3%(48/52),DBE检查病因诊断率显著高于CE检查,差异有统计学意义(P0.01);CE和DBE检查发现血管病变、肿瘤隆起病变与憩室分别为22.6%(24/106)、0.9%(1/106)和51.9%(27/52)、15.4%(8/52),DBE对血管病变、肿瘤隆起病变与憩室病因的诊断率高于CE,二者比较差异有统计学意义(P0.05)。结论在小肠出血患者中CE检查对血管病变、肿瘤隆起病变与憩室的病因诊断低于DBE检查;CE序贯联合DBE检查应用能提高小肠出血疾病的病变检出率及病因诊断率。     

A comparison between capsule endoscopy and double balloon enteroscopy using propensity score-matching analysis in patients with previous obscure gastrointestinal bleeding

Background: Recently, diagnosis of obscure gastrointestinal bleeding (OGIB) has improved greatly due to introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). However, the efficacy of CE over DBE in patients with previous OGIB remains unclear. This study aimed to compare, in terms of diagnostic yield, the efficacy of DBE with that of CE in patients with previous OGIB.

Patients and methods: We enrolled 223 consecutive patients with previous OGIB who were treated between May 2007 and March 2012. We retrospectively evaluated the respective diagnostic yields of CE and DBE in patients with previous OGIB using propensity score-matching analysis. We compared the diagnostic yield of CE with that of DBE.

Results: The diagnostic yields were 41.9% in DBE group and 11.6% in CE group, respectively (p?<?.01). On logistic regression analysis, DBE was significantly superior to CE after matching (Odds ratio [OR], 4.25; 95% confidence interval [CI], 1.43–12.6; p?<?.01), even after adjustment for propensity score (OR, 5.65; 95% CI, 1.56?20.5; p?<?.01).

Conclusions: Our results indicate that DBE might be more useful and perhaps safer than CE in achieving a positive diagnosis in patients with previous OGIB.     

胶囊内镜和CT仿真内镜诊断小肠疾病的对照研究

目的评价胶囊内镜和cT仿真内镜（CTVE）在小肠病变诊断方面的临床应用价值。方法回顾性总结3l例临床怀疑小肠疾病行胶囊内镜和CTVE检查患者的临床资料,参照最终诊断结果（手术病例以病理诊断为金标准,非手术病例依据后续检查及随访结果给出最终诊断）统计胶囊内镜、CTVE以及二者联合的诊断阳性率并行对比分析。结果最终诊断阳性26例,包括小肠肿瘤性病变16例、非肿瘤性病变10例,阴性5例。胶囊内镜诊断阳性24例,包括小肠肿瘤性病变14例（其中2例定位不准确,7例不能定性）和非肿瘤性病变10例;CTVE诊断阳性17例,包括小肠肿瘤性病变14例（其中1例定位不准确,4例不能定性）和非肿瘤性病变3例;胶囊内镜联合CTVE诊断阳性26例,包括小肠肿瘤性病变16例、非肿瘤性病变10例。对于小肠肿瘤性病变,胶囊内镜和CTVE诊断阳性率相同,均为87．5％（14／16）;而在总体诊断阳性率方面,胶囊内镜为77．4％（24／31）,CTVE为54．8％（17／31）,胶囊内镜联合CT仿真内镜为83．9％（26／31）,二者联合总体诊断阳性率明显高于CTVE（P=0．004）,但与胶囊内镜比较差异无统计学意义（P〉0．05）,胶囊内镜与CTVE比较差异也无统计学意义（P=0．065）。结论胶囊内镜和CTVE均有助于小肠疾病的诊断,胶囊内镜在诊断小肠非肿瘤性病变方面更有优势,而CTVE在判断小肠肿瘤性病变的位置和结构方面优于胶囊内镜,二者联合使用可进一步提高检出小肠疾病的能力。     

MANAGEMENT OF OBSCURE GASTROINTESTINAL BLEEDING BASED ON THE CLASSIFICATION OF CAPSULE ENDOSCOPIC BLEEDING FINDINGS

Background: Double‐balloon endoscopy (DBE) and capsule endoscopy (CE) have been useful in managing obscure gastrointestinal bleeding (OGIB). However, DBE is invasive, complex and time‐consuming, therefore indications should probably be selective. The aim of this study was to evaluate the usefulness of the classification of the CE bleeding findings for determining the indications and timing of DBE in patients with OGIB. Methods: From February 2003 to January 2009, 123 patients with OGIB who underwent CE were included in this study. These CE findings were classified based on the bleeding source. Type CE‐I, II, III, IV and 0 indicate active bleeding, previous bleeding, lesions without active bleeding, a lesion outside of the small bowel, and no findings, respectively. We compared diagnostic yield and outcome between the classification and the findings of DBE or enteroclysis. Results: Comparisons of the positive findings rate with DBE or enteroclysis, the treatment rate and the rebleeding rate with the classification showed: CE‐Ia, 100% (6/6), 50% (3/6), 33.3% (2/6); Ib, 66.7% (4/6), 0% (0/6), 16.7% (1/6); IIa, 33.3% (1/3), 33.3% (1/3), 33.3% (1/3); IIb, 53.8% (7/13),15.4% (2/13), 30.8% (4/13); III, 100% (84/84), 9.5% (8/84), 8.3% (7/84); IV, 100% (2/2), 50% (1/2), 0% (0/2); and 0, 0% (0/9), 0% (0/9), 0% (0/9), respectively. Conclusions: The proportion of patients requiring treatment, the positive findings rate with DBE or enteroclysis and the rebleeding rates tended to be higher in the higher ranked classification types (CE‐I > II > III > IV > 0). These findings suggest that the classification can provide useful information on determining the indications and timing of DBE.     

Single center experience of capsule endoscopy in patients with obscure gastrointestinal bleeding

AIM:To identify optimum timing to maximize diagnostic yield by capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB).METHODS:We identified patients who underwent CE at our institution from August 2003 to December 2009.Patient medical records were reviewed to determine type of OGIB (occult,overt),CE results and complications,and timing of CE with respect to onset of bleeding.RESULTS:Out of 385 patients investigated for OGIB,284 (74%) had some lesion detected by CE.In 222 patients (...     

Double-balloon enteroscopy for obscure gastrointestinal bleeding: A single center experience in China

AIM: To evaluate the diagnostic value of double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding (OGIB). METHODS: The data about 75 OGIB patients who underwent DBE in January 2007-June 2009 in our hospital were retrospectively analyzed. RESULTS: DBE was successfully performed in all 75 patients without complication. Of the 75 patients, 44 (58.7%) had positive DBE findings, 22 had negative DBE findings but had potential bleeding at surgery and capsule endoscopy, etc . These 66 patients were fi...     

Clinical impact of multidetector computed tomography before double-balloon enteroscopy for obscure gastrointestinal bleeding

AIM: To evaluate the clinical impact of multidetector computed tomography (MDCT) before double-balloon endoscopy (DBE) for patients with obscure gastrointestinal bleeding (OGIB).METHODS: A retrospective analysis of prospectively collected cases with DBE and MDCT for overt OGIB was conducted from April 2004 to April 2010 at Changhua Christian Hospital. We evaluated the clinical impact of MDCT on the subsequent DBE examinations and the diagnostic yields of both MDCT and DBE respectively.RESULTS: From April 2004 to April 2010, a total of 75 patients underwent DBE for overt OGIB. Thirty one cases received MDCT followed by DBE for OGIB. The overall diagnostic yields of DBE and MDCT was 93.5% and 45.2%. The MDCT had a high diagnostic yield of tumor vs non-tumor etiology of OGIB (85.7% vs 33.3%, P = 0.014). Additionally, the choice of initial route of DBE was correct in those with a positive MDCT vs negative MDCT (100% vs 52.9%, P = 0.003).CONCLUSION: This study suggests MDCT as a triage tool may identify patients who will benefit from DBE and aid the endoscopist in choosing the most efficient route.     

Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

AIM To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding(OGIB) who underwent double balloon enteroscopy(DBE) after pre-procedure imaging [multiphase computed tomography enterography(MPCTE), video capsule endoscopy(VCE), or both] and assess the impact of imaging on DBE diagnostic yield.METHODS Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1~(st), 2002 to June 30~(th), 2013 at a single tertiary center.RESULTS Four hundred and ninety five patients(52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE(in 441 patients) increased the diagnostic yield of DBE(67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE(OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE(OR = 5.9, P 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.CONCLUSION DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.     

胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用

目的 探讨胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用.方法 连续调查299例因不明原因消化道出血或腹痛、腹泻等原因而行胶囊内镜检查者,对胶囊内镜阴性或诊断不确定者建议双气囊内镜检查.分析胶囊内镜后双气囊内镜检查者诊断和随访资料.结果 296例完成胶囊内镜检查,发现阳性138例(46.6%),可疑阳性68例(23.0%),阴性90例(30.4%).45例胶囊内镜可疑阳性者和7例阴性者接受双气囊内镜检查,分别检出31例和1例小肠病变.双气囊内镜可能存在假阴性结果8例,未发现假阳性者;胶囊内镜可能存在假阴性结果2例,并有8例假阳性.在胶囊内镜结果提示下,90.3%(28/31)患者经单侧双气囊内镜检查即发现病灶.平均随访期为17个月,93.5%的双气囊内镜明确诊断者得到有效治疗.二种检查方法耐受性好,无严重不良反应发生.结论 胶囊内镜对小肠病变检出率高,但其诊断不确定性也较高.双气囊内镜能明确大部分胶囊内镜可疑阳性者.胶囊内镜结合双气囊内镜检查的诊断策略能提高小肠疾病诊断率、指导治疗并改善患者预后.