双气囊小肠镜诊断不明原因消化道出血

Diagnostic yield of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding

目的:分析双气囊小肠镜(double-balloonenteroscopy,DBE)在不明原因消化道出血诊断中的价值。方法:回顾性分析我院2003年10月～2005年1月因隐性或显性不明原因消化道出血患者的资料,对经常规上、下消化道内镜检查均无异常发现的患者行DBE检查,并对其临床相关资料进行统计学分析。结果:本研究共包括152例患者(男79例,女73例),平均年龄48岁,其中135例表现为显性消化道出血,17例为隐性消化道出血。共进行了191例次DBE检查,平均检查时间为63.8min,其中经口检查60例,经肛检查53例,39例分别经口和经肛检查。DBE检查发现可解释出血原因的病变共115例(75.7%)(102例显性出血,13例隐血);5例病灶发生在常规上消化道内镜检查所能观察到的范围内。最常见的病变为小肠肿瘤(39.1%)和血管扩张(30.4%)。38.3%的患者接受了手术治疗,15.1%的患者有轻度黏膜擦伤或轻度自限性黏膜出血,无严重并发症发生。结论:DBE检查对不明原因消化道出血的患者具有较高的诊断价值。

Objective To evaluate the diagnostic yield and therapeutic impact of double-balloon enteroscopy （DBE） on the management of patients with obscure gastrointestinal bleeding （OGIB）. Methods The patients with overt or occult OGIB admitted to our hospital from Dec 2003 to Jan 2005, who underwent DBE after negative standard upper and lower endoscopies, were retrospectively analyzed. Demographic, clinical, procedural and management outcome data were collected. Results One hundred and fifty two patients （73 women, 79 men） were studied, with a mean age of 48 years. Seventeen patients presented with occult OGIB while 135 patients had overt OGIB. A total of 191 DBEs were performed with a mean procedure duration of 63.8 minutes. Antegrade and retrograde approaches were performed in 60 and 53 patients respectively, and 39 patients had a combination of both routes. DBE demonstrated a potential bleeding site in 115 （75.7%） patients （102 overt, 13 occult）. Five （3.3%） lesions were found within the reach of a standard upper endoscope. Forty-four（38.3%） patients had surgery procedures after DBE exam. The management of 83.5% of patients with positive findings was altered due to DBE. The procedure was well tolerated, only 23（15.1%）patients experiencing mild self-limited mucosal bleeding during the procedure. Conclusions DBE has a high diagnostic yield and therapeutic impact on OGIB patients with previously negative upper and lower endoscopiec results.