北京市三级医院小肠疾病诊治现状

Current status of clinical management for small-bowel diseases in Beijing tertiary hospitals

目的调查北京市三级医院小肠疾病诊治现状以及小肠内镜使用情况。方法采用网络问卷调查北京市29家三级医院小肠疾病诊治设备的装备情况、胶囊内镜和气囊电子小肠镜应用、指南掌握和参加继续教育情况、不明原因消化道出血(obscure gastrointestinal bleeding,OGIB)诊治流程等。结果北京市29家三级医院中,24家(82.8%)配备胶囊内镜,12家(41.4%)配备了气囊电子小肠镜,中位装备时间5~6年。胶囊内镜中位年诊治例数50~100例,无效检查率达1%~3%;气囊电子小肠镜中位年诊治例数小于50例,无效检查率达3%~5%;两种小肠内镜严重合并症发生率<1%,整体阳性率50%~60%。各胶囊内镜阳性率与该院年诊治例数呈正相关(r=0.542,P=0.005)。仅有半数受访者掌握小肠疾病诊治指南,20.7%受访者从未参加相关继续教育项目。受访医生是否从事小肠内镜相关工作影响对首诊阴性OGIB病人的进一步诊治策略(χ2=3.898,P=0.048)。结论北京市三级医院胶囊内镜普及率高于气囊电子小肠镜,两者安全性较高,整体阳性率50%~60%。医生对指南规范掌握不足,需要加强继续教育,OGIB诊治流程有待进一步规范。

Objective To investigate the current diagnosis and treatment status of small-bowel diseases and clinical application of small-bowel endoscopy in Beijing tertiary-level hospitals.Methods The internet-based questionnaire was used to investigate the application of capsule endoscopy （CE） and balloon assisted enteroscopy （BAE）,proficiency in current guidelines and continuing medical education （CME） activities,as well as management strategy for obscure gastrointestinal bleeding （OGIB）.Results Twenty nine tertiary-level hospitals in Beijing were investigated.24 （82.8%） hospitals equipped with CE and 12 （41.4%） with BAE.The median application time was 5-6 years.Median cases received CE per hospital one year was 50-100 with a failure rate of 1%-3%.While median cases received BAE per hospital one year was less than 50 with a failure rate of 3%-5%.The incidence of severe complications of CE and BAE was less than 1% and overall diagnosis rate was 50%-60%.The positive rate of CE of each hospital was positive correlation with received CE cases per year（r=0.542,P=0.005）.Only half of the respondents mastered the guideline of CE and 20.7% never attended CME program.Respondents engaged in small-bowel endoscopy working had different diagnosis strategies for first diagnosed negative OGIB patients with those not engaged in small-bowel endoscopy working（χ^2=3.898,P=0.048）.Conclusion More hospitals are equipped with CE than BAE in Beijing tertiary-level hospitals.Both CE and BAE are safe for clinic use with similar diagnostic yield of 50%-60%.Physicians have insufficient knowledge of guideline and standard process of CE and more continued medical education （CME） should be recommended in the future.The procedure of diagnosis and treatment for OGIB needs to be further standardized.