胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用

Effect of capsule endoscopy followed by double-balloon enteroscopy in diagnosis of small bowel disease

目的探讨胶囊内镜结合双气囊内镜检查在小肠疾病诊断中的作用。方法连续调查299例因不明原因消化道出血或腹痛、腹泻等原因而行胶囊内镜检查者，对胶囊内镜阴性或诊断不确定者建议双气囊内镜检查。分析胶囊内镜后双气囊内镜检查者诊断和随访资料。结果296例完成胶囊内镜检查，发现阳性138例（46．6％），可疑阳性68例（23．0％），阴性90例（30．4％）。45例胶囊内镜可疑阳性者和7例阴性者接受双气囊内镜检查，分别检出31例和1例小肠病变。双气囊内镜可能存在假阴性结果8例，未发现假阳性者；胶囊内镜可能存在假阴性结果2例，并有8例假阳性。在胶囊内镜结果提示下，90．3％（28／31）患者经单侧双气囊内镜检查即发现病灶。平均随访期为17个月，93．5％的双气囊内镜明确诊断者得到有效治疗。二种检查方法耐受性好，无严重不良反应发生。结论胶囊内镜对小肠病变检出率高，但其诊断不确定性也较高。双气囊内镜能明确大部分胶囊内镜可疑阳性者。胶囊内镜结合双气囊内镜检查的诊断策略能提高小肠疾病诊断率、指导治疗并改善患者预后。

Objective To evaluate the clinical effect of capsule endoscopy （CE） followed by a directed double-balloon enteroscopy （DBE） in diagnosis of patients with suspected small bowel disease. Methods Two hundred and ninety-nine consecutive patients with obscure gastrointestinal bleeding or other various indications for CE examination were analyzed. DBE was recommended after negative or indeterminate evaluation on CE. The diagnostic and follow-up data were collected and analyzed. Results A total of 296 patients completed CE examination. Of whom, 138 （46.6 % ） cases had positive findings, 68 （23.0%） cases were suspected for small bowel disease and 90 （30, 4%） cases had negative finding. Those who were suspected （45 cases ） and negative （7 cases） for CE examination were performed DBE examination and small bowel lesions were found in 31 cases and 1 case, respectively. The false-negat!ve diagnosis was probably made by DBE in 8 patients, whereas no false-positive case was found by DBE. The false-negative diagnosis was probably made by CE in 2 patients, whereas 8 false-positive cases were found by CE. With the results of CE examination, lesions were found by only one-side procedure of DBE in 90. 3% （28/31） of patients. The results that followed up for median 17 months indicated that 93. 5% of patients with positive findings by DBE were received optimal therapy. Both CE and DBE procedures were well tolerated and no severe complications occurred. Conclusions The detection rate of small bowel lesions with CE was high, whereas the indetermination of CE findings was also significant. Majority of suspected findings by CE may be further confirmed by DBE. The strategy that start with CE and followed by DBE may increase diagnostic yield in patients with suspected small bowel disease and improve the prognosis.