气囊辅助小肠镜对不明原因消化道出血的诊断和治疗价值

Diagnostic and Therapeutic Value of Balloon-assisted Enteroscopy in Obscure Gastrointestinal Bleeding

背景:不明原因消化道出血(OGIB)的诊治是临床一大难题,气囊辅助小肠镜(BAE)对OGIB的诊断具有独到优势。目的:探讨BAE对OGIB的诊断和治疗价值。方法:收集2009年1月—2015年3月中国人民解放军空军总医院诊断为OGIB并接受BAE检查的患者124例,回顾性分析入选者的BAE诊断结果、治疗、随访、并发症等。对双气囊小肠镜(DBE)、单气囊小肠镜(SBE)经口、经肛检查进行比较。对BAE与胶囊内镜(CE)、消化道钡剂造影、血管造影的诊断效率进行比较。结果:DBE与SBE经口、经肛检查的进镜深度、进镜时间以及阳性检出率差异均无统计学意义(P>0.05)。BAE、CE、消化道钡剂造影、血管造影的阳性检出率分别为68.5%(85/124)、51.1%(24/47)、38.1%(8/21)以及21.4%(3/14),BAE的阳性检出率显著高于CE、消化道钡剂造影以及血管造影(P<0.05)。BAE、CE、消化道钡剂造影以及血管造影的特异性分别为97.5%、62.5%、54.5%以及66.7%,敏感性分别为100%、65.2%、30.0%以及12.5%,BAE的特异性和敏感性均显著高于CE、消化道钡剂造影以及血管造影(P<0.05)。23例患者行BAE镜下治疗,治疗后出血均停止。124例患者均完成BAE检查,无并发症发生。结论:BAE是一项安全、有效的诊断和治疗OGIB的方法。

Diagnosis and treatment of obscure gastrointestinal bleeding （OGIB） is a difficult problem in clinics, and balloon-assisted enteroscopy （BAE） has unique advantage in diagnosis of OGIB. Aims： To investigate the diagnostic and therapeutic value of BAE in OGIB. Methods： A total of 124 OGIB patients undergone BAE from Jan. 2009 to Mar. 2015 at Air Force General Hospital of Chinese PLA were enrolled, and the diagnostic result, treatment, follow-up and complications were retrospectively analyzed. Double-balloon enteroscopy （DBE） and single-balloon enteroscopy （SBE） by oral and anal route were compared. Also, diagnostic efficiency of BAE, capsule endoscopy （ CE）, gastrointestinal barium examination and angiography were compared. Results： No significant difference was found between DBE and SBE in insertion depth, procedure time and positive detection rate by oral and anal route （ P 〉 0.05 ）. Positive detection rates of BAE, CE, gastrointestinal barium examination and angiography were 68.5% （85/124）, 51.1% （24/47）, 38.1% （8/ 21 ） and 21.4% （3/14）, respectively; the detection rate of BAE was significantly higher than the others （ P 〈 0.05 ）. Specificity of BAE, CE, gastrointestinal barium examination and angiography were 97.5% , 62.5% , 54.5% and 66.7% , respectively; and sensitivity were 100% , 65.2% , 30.0% and 12.5%, respectively. Specificity and sensitivity of BAE were significantly higher than the others （ P 〈 0.05 ）. Endoscopic therapy performed by BAE in 23 patients were all successful. All of the 124 patients completed the BAE examination and no complication occurred. Conclusions： BAE is a safe and effective diagnostic and therapeutic tool for OGIB.