第二代结肠胶囊内镜临床应用的初步探讨

Primary study on clinical applications of second generation colon capsule endoscopy

目的初步探讨第二代结肠胶囊内镜的临床应用。方法纳入2017年7月至2018年12月于浙江大学医学院附属第一医院行结肠胶囊内镜检查的所有门诊和住院患者40例。由具有小肠或结肠胶囊内镜丰富判读经验的消化内科主任医师分析检查结果,观察胶囊在胃、小肠和结肠的通过时间,以及结肠清洁程度评分、胶囊检查完成率、病变检出情况和检查过程中的不良反应。采用卡方检验和Student′t检验进行统计学分析。结果65.0%(26/40)的患者在胶囊运行时间内完成全消化道检查,胃通过时间为(0.92±0.74)h,小肠通过时间为(3.93±1.51)h,结肠通过时间为(4.89±0.61)h。完成全消化道检查患者的胶囊运行时间短于未完成全消化道检查者[(9.44±3.53)h比(15.47±2.09)h],差异有统计学意义(t=6.79,P<0.01)。结肠准备合格率为67.5%(27/40)。结肠准备合格患者胶囊结肠通过时间、胶囊排空时间与结肠准备欠佳患者比较[分别为(4.43±3.33)h比(5.96±2.44)h,(9.06±3.91)h比(10.29±2.47)h]差异均无统计学意义(t=1.17、0.81,P均>0.05)。结肠胶囊内镜共发现33例(82.5%)患者存在消化道病变,其中食管病变3例,包括炎症与占位;胃病变21例,包括慢性胃炎、黏膜隆起、息肉和溃疡;小肠病变9例,包括息肉、溃疡和血管畸形;结肠病变19例,包括憩室、息肉、直肠炎、溃疡和糜烂、血管畸形、内痔;存在2种及以上病变的患者有11例。所有患者在检查过程中均未出现任何不良反应,均在吞入胶囊48 h内排出胶囊。结论第二代结肠胶囊内镜可用于全消化道检查,具有较高的安全性和耐受性。

Objective To explore the clinical applications of second generation colon capsule endoscopy(CCE-2).Methods From July 2017 to December 2018,at the First Affiliated Hospital,College of Medicine,Zhejiang University,40 outpatients and hospitalized patients who underwent CCE-2 examination were enrolled.The examination results were analyzed by an expert gastroenterologist with rich experience in small intestinal and colon capsule endoscopy.The stomach,small bowel and colon transit time,the score of colon cleansing quality,the completion rate of colon capsule examination,lesion detection and adverse effects were observed.Chi-square test and Student′t test were used for statistical analysis.Results The whole gastrointestinal tract examination was completed during the capsule running time in 65.0%(26/40)of the patients.The average stomach transit time was(0.92±0.74)h,the small bowel transit time was(3.93±1.51)h and the colon transit time was(4.89±0.61)h.The capsule running time of patients who completed the whole gastrointestinal tract examination was shorter than that of patients who did not complete the whole gastrointestinal tract examination((9.44±3.53)h vs.(15.47±2.09)h),and the difference was statistically significant(t=6.79,P<0.01).The qualified rate of colon preparation was 67.5%(27/40).There were no statistically significant differences in colon transit time or capsule excretion time between patients with qualified colon preparation and poor colon preparation((4.43±3.33)h vs.(5.96±2.44)h;and(9.06±3.91)h vs.(10.29±2.47)h;t=1.17 and 0.81,both P>0.05).A total of 33(82.5%)patients had gastrointestinal lesions detected by colon capsule,including three cases of esophageal lesions(inflammation and mass),21 cases of gastric lesions(chronic gastritis,mucosal protrusion,polyp and ulcer),nine cases of small bowel lesions(polyp,ulcer and vascular malformation)and 19 cases of colonic lesions(diverticulum,polyp,rectitis,mucosal erosion,ulcer and vascular malformation,internal hemorrhoids).Among them,there were 11 patients with two or more lesions.No adverse events occurred during the examination and all the capsules were excreted within 48 hours.Conclusion CCE-2 with high safety and good tolerance can be used for whole gastrointestinal tract examination.