胶囊内镜检查不明原因消化道出血临床转归115例

Influence of capsule endoscopy on the clinical outcomes of patients with obscure gastrointestinal bleeding:an analysis of 115 cases

目的:探讨胶囊内镜诊断不明原因消化道出血(OGIB)的可靠性及根据其诊断结果指导疾病,临床转归的有效性.方法:收集2002-05/2005-06间因不明原因消化道出血连续至本院行胶囊内镜检查的患者99例,通过就诊记录、电话追踪和门急诊随访等分析胶囊内镜诊断结果的临床符合情况、根据该诊断指导干预措施的结果、患者再出血及再检查等情况.结果:胶囊内镜对OGIB的病变检出率为89.9%,平均随访时间为18.4(6-41)mo,63例(63.6%)胶囊内镜检查结果得以验证,病变检出率在验证前后无显著差异(P=0.36),最终确诊率达90.5%(57/63).根据胶囊内镜诊断结果指导的特异性治疗率为50.5%(50/99),总成功率为82%(41/50),且经胶囊内镜诊断结果指导的对小肠阳性病变的有效干预率显著高于可疑阳性病变(P=0.01).结论:胶囊内镜诊断不明原因消化道出血的准确性高,能有效指导对疾病的进一步治疗,并能较大程度地影响这些疾病,特别是溃疡、肿瘤及血管发育不良所致的不明原因消化道出血的临床转归.

AIM： To evaluate the accuracy of the diagnosis of OGIB by capsule endoscopy and the effectiveness of this technique in obtaining a suitable clinical outcome. METHODS： From May 2002 to June 2005, 99 patients were enrolled in our study of capsule endoscopy for OGIB. We analyzed the degree of consistency between findings by capsule en- doscopy and the clinical results, the outcome of treatments based on its diagnosis, the occurrence of re-bleeds and the re-examinations of the patients through records of consultations, emergencies or hospitalizations and telephone follow-up. RESULTS： Capsule endoscopy successfully detected 89.9% of cases of OGIB. At a mean follow-up of 18.4 （6-41） months, lesions detected by capsule endoscope in 63 （63.6%） patients were verified. Among these patients, capsule endoscopy accurately diagnosed 90.5% （57/63） of OGIB cases, and this was not significantly different from the accuracy of diagnosis before validation （P = 0.36）. Specific interventions were undertaken in 50.5% （50/99） of cases based on the findings of capsule endoscopy, The success rate of these specific strategies was 82% （41/50）. Interventions based on positive findings in the small bowel are clearly more effective than those based on probable-positive findings （P = 0.01）. CONCLUSION： Capsule endoscopy has a high accuracy for the diagnosis of OGIB; this technique can efficiently guide further strategies and, in a relatively major proportion of cases, affect the clinical outcomes of these patients, especially bleeding caused by tumors, ulcers and angiodysplasia.