可分离式牵线磁控胶囊内镜在50例肝硬化合并食管胃静脉曲张患者内镜治疗后随访评估中的应用

Application of detachable string-magnetically controlled capsule endoscopy in the evaluation of post-endoscopic treatment of 50 liver cirrhosis patients with esophagogastric varices during follow-up

目的以电子胃镜为金标准,探索可分离式牵线磁控胶囊内镜(DS-MCE)用于肝硬化合并食管胃静脉曲张患者经内镜治疗后随访评估中的价值。方法选择2019年7月1日至2021年12月31日因肝硬化合并食管胃静脉曲张并接受内镜治疗后于上海交通大学医学院附属瑞金医院随访的50例患者,所有患者依次接受DS-MCE和电子胃镜检查,对比分析2种内镜检查方法对食管胃静脉曲张的检出,食管静脉曲张直径分级和出血危险因素分级的评估情况(包括灵敏度、特异度、阳性预测值、阴性预测值),以及门静脉高压性胃病及其严重程度的诊断情况,并分析以及患者对2种内镜检查方法的满意度(检查前感知和检查后满意度分析)。统计学方法采用Kruskal-Wallis检验和Kappa检验。结果DS-MCE检出食管静脉曲张的灵敏度、特异度、阳性预测值、阴性预测值分别为100.0%(43/43)、85.7%(6/7)、97.7%(43/44)和100.0%(6/6),DS-MCE评估食管静脉曲张直径分级的准确度为86.0%(43/50),与电子胃镜的一致性较好,Κappa值为0.797(P<0.001)。DS-MCE检出具有出血危险因素的食管静脉曲张的灵敏度、特异度、阳性预测值、阴性预测值分别为94.4%(34/36)、100.0%(14/14)、100.0%(34/34)和87.5%(14/16),DS-MCE评估食管静脉曲张出血危险因素分级的准确度为94.0%(47/50),与电子胃镜的一致性较好,Kappa值为0.862(P<0.001)。DS-MCE检出胃静脉曲张的灵敏度、特异度、阳性预测值、阴性预测值分别为85.7%(18/21)、93.1%(27/29)、90.0%(18/20)和90.0%(27/30)。DS-MCE检出门静脉高压性胃病的灵敏度、特异度、阳性预测值、阴性预测值均为100.0%(50/50),DS-MCE与电子胃镜对门静脉高压性胃病严重程度分级的一致性较好,Kappa值为0.962(P<0.001)。检查前感知分析显示,DS-MCE在患者检查前心理紧张度、预期疼痛感方面均优于电子胃镜(H=16.04、23.74,均P<0.001)。检查后满意度分析显示,DS-MCE在吞咽难易程度、检查中疼痛感、检查中不适感、检查后疼痛感、检查后不适感、检查舒适程度、检查方便性、再次选择该检查方法作为胃部检查手段的意愿度方面均优于电子胃镜(H=17.28、30.88、44.68、34.66、48.05、22.74、13.03、17.19,均P<0.001)。结论以电子胃镜为金标准,DS-MCE检查能较准确地评估肝硬化合并食管胃静脉曲张患者经内镜治疗后食管静脉曲张、胃静脉曲张、门静脉高压性胃病等情况,且安全可行、舒适度高,有望成为此类患者内镜随访的有效备选方案。

Objective To explore the value of detachable string-magnetically controlled capsule endoscopy(DS-MCE)in the evaluation of post-endoscopic treatment of liver cirrhosis patients with gastroesophageal varices during follow-up,and conventional electronic esophagogastroduodenoscopy(EGD)was used as the gold standard.Methods From July 1,2019 to December 31,2021,50 follow-up patients with gastroesophageal varices due to liver cirrhosis and had a past medical history of endoscopic treatment in Ruijin Hospital,Shanghai Jiaotong University School of Medicine were selected.DS-MCE and EGD were performed in turn.The 2 endoscopic examination methods were compared and analyzed in the assessment of detecting gastroesophageal varices,grading of diameter of esophageal varices and classification of bleeding risk factors(including sensitivity,specificity,positive predictive value and negative predictive value),diagnosis of portal hypertensive gastropathy and its severity,and the patients′satisfaction(pre-procedural perceptual and post-procedural satisfaction).Kruskal-Wallis test and Kappa test were used for statistical analysis.Results The sensitivity,specificity,positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices were 100.0%(43/43),85.7%(6/7),97.7%(43/44)and 100.0%(6/6),respectively.The accuracy of DS-MCE in evaluating the grading of esophageal varices was 86.0%(43/50),with good consistency of EGD,and the Kappa value was 0.797(P<0.001).The sensitivity,specificity,positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices with bleeding risk factors were 94.4%(34/36),100.0%(14/14),100.0%(34/34)and 87.5%(14/16),respectively.The accuracy of DS-MCE in evaluating esophageal varices with bleeding risk factors was 94.0%(47/50),with good consistency of EGD,and the Kappa value was 0.862(P<0.001).The sensitivity,specificity,positive predictive value and negative predictive value of DS-MCE in the diagnosis of gastric varices were 85.7%(18/21),93.1%(27/29),90.0%(18/20)and 90.0%(27/30),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of DS-MCE in the diagnosis of portal hypertensive gastropathy were all 100.0%(50/50).The consistency of DS-MCE and EGD in the severity grading of portal hypertensive gastropathy was good,the Kappa value was 0.962(P<0.001).The results of pre-procedural perceptual analysis showed that patients′psychological tension before examination and expected pain before examination of DS-MCE were better than those of EGD(H=16.04 and 23.74,both P<0.001).The results of satisfactory analysis after examination indicated that DS-MCE was better than EGD in the degree of difficulty in swallowing,pain and discomfort during examination,pain and discomfort after examination,comfort degree during examination,convenience of the procedure and willingness of receiving such examination again as gastric examination method(H=17.28,30.88,44.68,34.66,48.05,22.74,13.03 and 17.19,all P<0.001).Conclusions With EGD as the gold standard,DS-MCE can accurately evaluate gastroesophageal varices and portal hypertensive gastroenteropathy after endoscopic treatment in patients with liver cirrhosis and gastroesophageal varices,and it is a safe and comfortable method.DS-MCE can be an efficient alternative method in endoscopic follow-up of such patients.