双气囊小肠镜在疑似小肠出血中的临床应用:一项单中心回顾性队列研究

Clinical application of double-balloon enteroscopy in suspected small bowel bleeding:a single-center retrospective cohort study

目的探讨近10年双气囊小肠镜(double-balloon enteroscopy,DBE)检查疑似小肠出血(suspected small bowel bleeding,SSBB)的适应证、诊断率及不良事件的变化。方法回顾性分析某三级医院第1阶段(较早阶段,2013年9月至2018年8月)和第2阶段(较晚阶段,2018年9月至2023年8月)完成DBE检查患者的临床及内镜资料。结果共纳入451例患者(第1阶段214例,第2阶段237例)。第2阶段中从最后一次出血到DBE检查的时间间隔比第1阶段更短[(5.8±1.3)d vs(6.6±1.8),P<0.001]。第2阶段显性出血比例和全小肠检查率(total enteroscopy rate,TER)均高于第1阶段(89.9%vs 79.9%,P<0.05;88.4%vs 59.0%,P<0.001)。肿瘤(26.4%)、克罗恩病(15.7%)和憩室(12.6%)是SSBB的前三大常见病因。第2阶段血管病变的诊断率和比例高于第1阶段(85.7%vs 66.8%,P<0.01;13.5%vs 3.7%,P<0.05)。两阶段检查相关不良事件发生率差异无统计学意义(2.1%vs 3.7%,P>0.05)。结论DBE诊断SSBB有效、安全。随着时间推移,显性出血作为DBE检查的适应症变得越来越普遍。与第1阶段相比,第2阶段DBE的诊断率有所提高,并发症发生率无显著差异。

Objective To investigate the changes in clinical practice,including indication,diagnostic rate and adverse event of double-balloon enteroscopy(DBE)for suspected small bowel bleeding(SSBB)in last ten years.Methods The clinical and endoscopic data of patients who underwent DBE in a tertiary hospital between the first stage(from Sep.2013 to Aug.2018)and the second stage(from Sep.2018 to Aug.2023)were retrospectively reviewed.Results A total of 451 patients were included(214 in the first stage and 237 in the second stage).In the second stage,the time interval from the last bleeding to DBE procedure was shorter than that in the first stage[(5.8±1.3)d vs(6.6±1.8)d,P<0.001].Compared with the first stage,the proportion of overt bleeding as indication and the total enteroscopy rate(TER)was higher than that in the second stage(89.9%vs 79.9%,P<0.05;88.4%vs 59.0%,P<0.001,respectively).Tumor(26.4%),Crohn's disease(15.7%)and diverticulum(12.6%)were the top 3 common causes of SSBB.The diagnostic yield and the proportion of angioectasias in the second stage were higher than those in the first stage(85.7%vs 66.8%,P<0.01;13.5%vs 3.7%,P<0.05,respectively).There was no significant difference in the rate of adverse event between two stages(2.1%vs 3.7%,P>0.05).Conclusion DBE is effective and safe for the diagnosis of SSBB.Overt bleeding as indication for DBE has become more common over time.Compared with the first stage,diagnostic rate of DBE has increased and complication rate is not different in the second stage.