胶囊内镜与双气囊小肠镜对小肠疾病诊断的荟萃分析

Capsule endoscopy compared with double-balloon enteroscopy in the diagnosis of small bowel diseases:A meta-analysis

目的比较胶囊内镜和双气囊小肠镜对小肠疾病的阳性检出率。方法从 Medline、Embase、Elsevier ScienceDirect 和中国期刊全文数据库中检索比较胶囊内镜和双气囊小肠镜对小肠疾病阳性检出率的前瞻性研究。对各项研究中2种内镜的阳性检出率比数比(OR)行荟萃分析,经异质性检验后采用固定效应模型或随机效应模型进行统计分析。并根据可能产生异质性的原因进行分层分析。结果共有8项研究入选(n=277)。荟萃结果表明,胶囊内镜和双气囊小肠镜对小肠疾病阳性检出率没有显著差别[170/277比156/277,随机效应模式:OR 为1.21(95%可信区间 CI:0.64,2.29)]。分层分析提示:胶囊内镜的阳性率显著高于未采用经口和经肛这2种进镜方式相结合的双气囊小肠镜[137/219比110/219,固定效应模式:OR 为1.67(95%CI:1.14,2.44),(P<0.01)];而低于用这2种进镜方式相结合的双气囊小肠镜检查,但差异没有统计学意义[26/48比37/48,随机效应模式:OR 0.33(95%CI:0.05,2.21),(P>0.05)]。进一步对5项全文发表的关于对不明原因消化道出血诊断的研究进行荟萃,结果仍然提示胶囊内镜的阳性检出率明显高于未采用经口和经肛这2种进镜方式相结合的双气囊小肠镜[118/191比96/191,固定效应模式:OR1.61(95%CI:1.07,2.43),(P<0.05)],但显著低于2种进镜方式相结合的双气囊小肠镜检查[11/24比21/24,固定效应模式:OR 0.12(95%CI:0.03,0.52),(P<0.01)]。结论双气囊小肠镜经口和经肛2种进镜方式联合应用的阳性率可能高于胶囊内镜,对这2种内镜的选择,应该取决于病人的一般状况及其意愿,医疗单位所具备的能力,以及病灶是否可能需要采取进一步的介入治疗。

Objective Capsule endoscopy and double-balloon enteroscopy arc both effective tools for the diagnosis of small bowel disease. We performed a meta-analysis to compare the yield of capsule endoscopy（CE） with that of double-balloon enteroscopy （DBE）. Methods Pubmed, Embase, Elsevier ScienceDirect and the China Academic Journals Full-text Database were searched for the trials comparing the yield of CE with that of DBE. Outcome measure was odds ratio （OR） of the yield. Fixed or random model method was used for data analysis. Results Eight studies （ n = 277 ） which prospectively compared the yield of CE with that of DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE [ 170/277 vs 156/277, OR 1.21 （95% CI：0. 64, 2. 29） ]. Based on subanalysis, the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches [ 137/219 vs 110/219, OR 1.67 （95% CI： 1.14, 2. 44） , （P 〈 0. 01 ） ], but not superior to the yield of DBE with combination of the two insertion approaches[ 26/48 vs 37/ 48, OR 0. 33 （95% CI：0. 05, 2. 21 ） , （P 〉0. 05） ]. A focused metanalysis of five fully published articles about obscure GI bleeding was also performed and showed that the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches [ 118/191 vs 96/191, fixed mod-el ： OR1. 61 （95% CI ： 1.07, 2. 43）, （ P 〈 0. 05） ] ; the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches [ 11/24 vs 21/24, fixed model： OR 0. 12 （95% CI：0. 03,0. 52） , （P 〈 0. 01 ） ]. Conclusion With combination of oral and anal approaches, the yield of DBE might be at least as high as that of CE. Decision made on choosing the initial approach should depend on patient＇s physical status, technology availability, patient＇s preferences, and potential for therapeutic endoscopy.