双气囊小肠镜与胶囊内镜诊断小肠出血病因比较

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

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 2 4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 2 4例患者中 2 1例通过小肠镜检查发现病灶 ,总检出率为 87.5 %。 2 4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 2 5 %。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。

Objective To evaluate the diagnostic yield and accuracy of double balloon enteroscopy and capsule endoscopy in patients with obscure small bowel hemorrhage. Methods Twenty four patients with obscure small bowel hemorrhage were performed double balloon enteroscopy and wireless capsule endoscopy separately. The route of enteroscopy could be underwent either via mouth or via anus. Negative result of initial route was required afterwards for another via mouth or via anus examination. Capsule endoscope produced by GIVEN Imaging Company was used. The results of both methods were analyzed independently and final diagnosis of each case was compared thereafter. Results Totally 21 of 24 (87.5%) patients had positive findings with enterosocpy, while 11 of 24 (45.8%) patients had positive findings with capsule endoscopy. The etiological diagnosis of enteroscopy in all cases was confirmed by surgical exploration and pathological examination with the accuracy of 87.5% , however, the accuracy of capsule endoscopy was only 25% (6 cases). On assessment of procedure tolerance, double balloon enteroscopy under anaesthesia and capsule endoscopy were well tolerated than via mouth or anus route enteroscopy without anaesthesia. There was no severe procedure related complications. Conclusions The entire small intestine could be examined by double balloon enteroscopy with combination of mouth and anus route. Double balloon enteroscopy was superior to capsule endoscopy in etiological diagnosis of obscure small bowel bleeding. Capsule endoscopy had clinical diagnostic value in detection of multiple and long segment small bowel lesions. Double balloon enteroscopy could be served as the first option in diagnosis of obscure small bowel bleeding.