胶囊内镜与双气囊小肠镜诊断不明原因消化系出血的Meta分析

Double balloon enteroscopy vs capsule endoscopy for obscure gastrointestinal bleeding:A Meta-analysis

目的:比较胶囊内镜与双气囊小肠镜对不明原因消化系出血的诊断价值,用以评估不明原因消化系出血患者的最优检查方案.方法:通过PubMed、Medline、维普、万方、中国知网、中国生物医学文献数据库检索2003-01/2013-01期间发表的同时使用胶囊内镜与双气囊小肠镜诊断不明原因消化系出血的前瞻性随机对照临床试验的文章.由2名评价员独立对纳入文献进行质量评价和数据提取,并使用RevMan5软件进行Meta分析.结果:按照入选标准,有13项前瞻性随机对照临床试验纳入.Meta分析结果显示:胶囊内镜和双气囊小肠镜对不明原因消化系出血的诊断率没有显著差别(OR=1.19,95%CI:0.74-1.91,P=0.48).亚组分析表明胶囊内镜阳性后进行小肠镜检查与小肠镜在所有患者中的诊断率比较没有显著差异(OR=1.50,95%CI:0.90-2.48,P=0.12).结论:胶囊内镜和双气囊小肠镜在不明原因消化系出血的患者中具有相似的诊断率,胶囊内镜阳性后再进行小肠镜检查并不能提高诊断率.

AIM： To compare the diagnostic value of double balloon enteroscopy versus capsule endoscopy in obscure gastrointestinal bleeding to help choose the optimal diagnostic strategy for this clinical condition. METHODS： A comprehensive literature search was performed in PubMed, Medline, Vip data-base, Wanfang database, China National Knowl-edge Infrastructure database （CNKI） and Chi-nese Biomedical Literature database （CBM） of randomized controlled clinical trial using double balloon enteroscopy and capsule endoscopy for the diagnosis of obscure gastrointestinal bleed-ing dating from January 2003 to January 2013. Data of included studies were extracted and their quality evaluated independently by two re-viewers. RevMan5 software was used for Meta-analysis. RESULTS： Based on inclusion criteria, 13 pro-spective randomized controlled clinical stud-ies were included in this study. Meta-analysis showed no significant difference in the diagnos-tic rate between double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding. Subgroup analysis showed that the diagnostic rate had no significant difference between enteroscopy in patients with positive results in previous capsule endoscopy and en-teroscopy in unselected patients. CONCLUSION： Double balloon enteroscopy and capsule endoscopy have similar diagnostic results in patients with obscure gastrointestinal bleeding, and enteroscopy after capsule endos-copy can not improve the diagnostic rate.