34例不明原因疑小肠出血的病因诊断——推进式双气囊小肠镜与小肠钡灌检查对比研究

Etiological Diagnosis of 34 Patients with Suspected Obscure Small Intestinal Bleeding -- A Comparative Study of Double-balloon Push Enteroscopy and Enteroclysis

背景:不明原因小肠出血的病因诊断较为困难,不同检查手段的临床实用价值有待进一步探讨。目的:通过对不明原因疑小肠出血患者分别行推进式双气囊小肠镜和小肠钡灌检查,比较两者对小肠出血的病变检出率、病因诊断准确率和临床实用价值。方法:34例不明原因疑小肠出血患者分别接受推进式双气囊小肠镜和小肠钡灌检查。推进式双气囊小肠镜检查的进镜方式分为经口腔和经肛门两种,以首选进镜方式检查后未发现病灶者,择期改换进镜方式再行检查。小肠钡灌检查采用插管式稀钡灌注法。两项检查分别由消化科和放射科医师独立操作并诊断,最后进行汇总分析。结果:在34例行推进式双气囊小肠镜检查的患者中,首选从口腔进镜者22例,其中14例(63.6%)检出病灶;8例未发现病灶者择期再从肛门进镜检查,6例检出病灶。12例首选从肛门进镜者中8例(66.7%)检出病灶;4例择期再从口腔进镜检查,3例检出病灶。推进式双气囊小肠镜检查的病变整体检出率为91.2%(31/34);小肠钡灌检查的病变整体检出率为50.0%(17/34)。推进式双气囊小肠镜检查发现的阳性病灶均经活检病理检查、手术探查以及临床治疗和随访结果证实,病因诊断准确率为100%(31/31);小肠钡灌检查的病因诊断准确率为48.4%(15/31)。全麻下经口腔进镜推进式双气囊小肠镜检查的患者耐?

The etiological diagnosis of obscure small intestinal bleeding is relatively difficult; the clinical value of various diagnostic modalities needs to be further investigated. Aims: To compare the diagnostic yield and accuracy rate of double-balloon push enteroscopy and enteroclysis in patients with suspected obscure small intestinal bleeding and their clinical practicability. Methods: Thirty-four suspected obscure small intestinal bleeding patients underwent double-balloon push enteroscopy and enteroclysis, respectively. The route of enteroscopy could be either via the mouth or via the anus. If the enteroscopy via the mouth had not found any lesions, then the examination via the anus would be performed afterwards, or vice versa. The enteroclysis was operated with special tube introduced to inlet of jejunum. Each of the above examinations was performed by gastroenterologists and radiologists, respectively, the results were judged independently and the final diagnosis was compared thereafter. Results: The double-balloon push enteroscopy was first performed via the mouth in 22 of 34 patients, and the lesions could be detected in 14 patients (63.6%), 6 of 8 patients had lesions detected by enteroscopy via the anus when nothing was found by the oral route. Among the 12 patients first examined by enteroscopy via the anus, lesions were detected in 8 patients (66.7%), 3 of 4 patients had the lesions found in the subsequent examination via the mouth. The overall diagnostic yield of double-balloon push enteroscopy was 91.2% (31/34), and that of enteroclysis 50.0% (17/34). The diagnosis of enteroscopy was confirmed by biopsy pathology, surgical exploration, clinical treatment and follow-up, the accuracy rate of etiological diagnosis was 100% (31/31), while that of enteroclysis was only 48.4% (15/31). The enteroscopy with general anesthesia via the mouth was well tolerated, followed by non-anesthesia enteroscopy via the anus, and non-anesthesia enteroscopy via the mouth and enteroclysis. No severe procedure-related complications were observed in any examined patients. Conclusions: The entire small intestine can be examined by double-balloon push enteroscopy with the combination of both oral and anal routes. In the etiological diagnosis of obscure small intestinal bleeding, enteroscopy is superior to enteroclysis. However, enteroclysis is still valuable for detection of small bowel stricture and tumor, and may be a useful screening alternative for subsequent procedure selection. Double-balloon push enteroscopy via the mouth under general anesthesia is a safe and acceptable modality with high diagnostic yield and high accuracy rate for various small bowel diseases.