胶囊内镜消化道转运时间影响因素分析

Analysis of Factors Influencing Gastrointestinal Transit Time of Capsule Endoscope

背景：PY囊内镜因具有良好的安全性、耐受性和有效性，目前已广泛应用于小肠疾病的诊断，能否在电池耗尽前完全通过小肠是决定胶囊内镜检查成功与否的关键因素之一。目的：探讨胶囊内镜消化道转运时间的影响因素。方法：对2009年1月-2012年12月于华西医院接受胶囊内镜检查的426例连续病例进行回顾性分析。以Cox比例风险回归模型分析胶囊内镜胃转运时间（GTF）和小肠转运时间（SBTT）的影响因素。结果：319例受检者完成全段小肠检查，检出病变317例，中位GTT和SBTT分别为33．3min和330．5min。在性别、年龄、小肠清洁程度和阳性诊断四个变量中，年龄与GTT呈正相关（OR=1．007，95％CI：1．001～1．013，P=0．032），小肠清洁程度与GTF（OR=0．874，95％CI：0．768-0．994，P=0．040）和SBTT（OR=0．769，95％CI：0．640-0．924，P=0．005）呈负相关。62例受检者胶囊内镜滞留于胃中，其中61例经口服多潘立酮片或胃镜推送后进入小肠。结论：较好的小肠清洁程度能缩短胶囊内镜的消化道转运时间。检查中应实时监测胶囊内镜通过情况，必要时可采取口服促动力药或胃镜推送以获得更短的转运时间。

Background： Capsule endoscopy （CE） is safe, effective and well tolerated, and has been widely used for the diagnosis of small intestinal diseases. Whether CE can entirely pass through the small bowel within its battery life is one of the crucial determinants of a successful CE examination. Aims： To identify the factors that affect gastrointestinal transit time of CE. Methods ： A retrospective analysis was conducted in 426 consecutive subjects received CE examination in West China Hospital from Jan. 2009 to Dec. 2012. Cox proportional hazards regression model was used to analyze the influencing factors of gastric transit time （GTI＇） and small bowel transit time （SBTI＇） of CE. Results ： CE was able to explore the entire small bowel in 319 of the subjects, and 317 lesions were detected. The median GTT and SBTY were 33.3 min and 330.5 min, respectively. In the four variables （gender, age, level of small bowel cleansing and diagnostic yield） enrolled in Cox regression, age was positively correlated with GTY （OR = 1. 007, 95% CI： 1. 001-1. 013, P = 0. 032）, and level of small bowel cleansing was negatively correlated with GTF （OR = 0.874, 95 % CI： 0. 768-0. 994 , P =0. 040） and SBTF （OR =0.769, 95% CI： 0.640-0. 924, P =0. 005）. Capsule retention in stomach occurred in 62 of the subjects, and 61 had capsules finally reached the cecum by oral administration of domperidone or via endoscopic placement. Conclusions ： Excellent small bowel cleansing is associated with a shortened gastrointestinal transit time of CE. The subject should be monitored with a real-time viewer during the CE procedure, and oral prokinetics or endoscopic placement should be administered to facilitate the transit of CE if necessary.