胶囊内镜胃-十二指肠往返运动对检查的影响

Influence of gastro-duodenal back-and-forth movement of capsule endoscope on capsule endoscopy examination

目的探讨胶囊内镜胃-十二指肠往返运动对胶囊内镜检查的影响和应采取的干预措施。方法回顾分析227例国产OMOM胶囊内镜检查病例的临床资料,按照胶囊由胃进入十二指肠的方式分为:(1)胶囊无往返运动而自行进入小肠的自主下行组(193例);(2)胶囊有胃-十二指肠往返运动的往返运动组(24例);(3)胶囊在胃内停留时间过长而需用胃镜送入小肠的胃内滞留组(10例)。统计分析往返运动组的往返时间、往返次数、到达部位等,比较三组之间胃通过时间(GTT)、全小肠检查完成率(CER)、完成全小肠检查者的小肠通过时间(SBTT)、胶囊滞留率等。结果共有10.6%(24/227)的病例存在胃-十二指肠往返运动;除1例胶囊始终往返运动而无法计算相应数据的病例,23例的往返时间为(36.4±33.1)min,往返次数为(8.1±19.6)次,胶囊到达部位十二指肠球部13例,球降交界部8例,降部2例;自主下行组的GTT为(40.4±32.4)min,往返运动组为(65.5±44.8)min,胃内滞留组为(141.9±54.8)min,三组之间和每组两两之间均有统计学差异(P均<0.05);三组之间CER、SBTT无统计学差异(P>0.05);胃内滞留组的滞留率20.0%(2/10)高于自主下行组1.0%(2/193)(P<0.01)。结论往返运动使该组的GTT长于自主下行组,而趋近于胃内滞留组,但对胶囊内镜检查的不良影响似乎并不严重,所以只要往返运动耽误的时间不是太长(GTT不超过90 min),可不必为患者做提前人工干预。

Objective To study the influence of gastro-duodenal back-and-forth movement of capsule endo- scope on capsule endoscopy （CE） examination and the needed intervention. Methods Two hundred and twenty- seven OMOM CE examinations were retrospectively analyzed, and the patients were divided into three groups accord- ing to the capsule-entered patterns from stomach to small bowel （SB） ： （ 1 ） autonomous group （ n = 193 ） ： the cap- sule entered SB autonomously without back-and-forth movement ; （ 2 ） back-and-forth group （ n = 24 ） ： the capsule possessed gastro-duodenal back-and-forth movement; （3） retention group （n = 10） ： the capsule of retention in the stomach needed gastroseopic help to enter duodenum. Time wasted in gastro-duodenal back-and-forth movement, number of times of back-and-forth movement of capsule between stomach and duodenum and the arrival distal end position of capsule during back-and-forth movement were retrospectively analyzed. Gastric transit time （ GTT）, com- plete examination rate （CER）, small bowel transit time （SBTT） and retention rate of capsule in the three groups were compared. Results Gastro-duodenal back-and-forth movement was found in 10.6% （24/227） of the patients. In 23 cases of back-and-forth group（ one case whose related indexes could not be calculated due to always existing back-and-forth movement was excluded）, the time wasted in back-and-forth movement was （ 36.4 ± 33. 1 ） rain, number of times of back-and-forth movement of capsule was （ 8.1 ± 19.6）, and the arrival distal end positions of cap- sule were duodenal bulb in 13 cases, junction of the first and second part of duodenum in 8 cases, and descending part of duodenum in 2 cases, respectively. The GYr in autonomous group, back-and-forth group and retention groups were （40.4 ± 32.4 ） min, （ 65.5 ± 44.8 ） min and （ 141.9 ± 54.8 ） min, respectively. There were statistical differences in GTY among the three groups or between every two groups （ all P 〈 0.05 ）, while there were no statisti- cal differences in CER and SBrI＇y in the three groups （ all P 〉0.05 ）. The retention rate in retention group was high- er than that in autonomous group [20.0% （2/10） vs 1.0% （2/193） ,P〈0.01]. Conclusions The back-and- forth movement makes the GTT of the back-and-forth group longer than that of the autonomous group and tend to that of the retention group, hut the adverse effect seems to be no serious. As long as GTT is not too long due to back-and-forth movement（ not more than 90 min） ,intervention is not necessary.