Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding

AIM:To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered during DBE.RESULTS: There were 228 (150 antegrade and 78 retrograde) DBE procedures performed in 179 patients. The mean number of DBE procedures was 1.27 per patient. The mean age (SD) of the patients was 62 ± 16 years old. There were 94 females (52.5%). The positive yield for a bleeding lesion was 65.9%. Of the 179 patients, 44 (24.6%) had NSBLs (19 of them had dual pathology with small-bowel lesions and NSBLs); 27 (15.1%) had lesions not detected by previous endoscopies. The most common type of missed lesions were vascular lesions.CONCLUSION: A significant proportion of patients (24.6%) had lesions within reach of conventional endoscopy. Careful repeat examination with gastroscopy and colonoscopy might be required.

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases

AIM: To compare the roles of capsule endoscopy(CE)and double-balloon enteroscopy(DBE) in the diagnosis of obscure small bowel diseases.METHODS: From June 2009 to December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions,fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into:(1) the definite diagnosis(the diagnosis was confirmed at least by one of the biopsy,surgery, pathology or the drug treatment effects with follow-up for at least 3 mo);(2) the possible diagnosis(a possible diagnosis was suggested by CE or DBE,but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and(3) the unclear diagnosis(no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. The differencein the etiologies between CE and DBE was estimated,and the different possible etiologies caused by the age groups were also investigated.RESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers(P = 0.242, Fisher's test), and small vascular malformations(χ 2 = 1.810,P = 0.179, Pearson χ 2 test), but with no significant differences, possible due to few cases. However,DBE was better than CE for larger tumors(P =0.018, Fisher's test) and for diverticular lesions with bleeding ulcers(P = 0.005, Fisher's test). All three hemangioma cases diagnosed by DBE in this study(including sponge hemangioma, venous hemangioma,and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates(DR) of CE(60.0%, 53/88) and DBE(59.1%, 52/88). However,the etiological diagnostic yield(DY) difference was apparent. The CE diagnostic yield was 42.0%(37/88),and the DBE diagnostic yield was 51.1%(45/88).Furthermore, there were differences among the age groups(χ 2 = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer(5/6 cases), vascular malformations(22/29 cases), and active bleeding(3/4cases) appeared more commonly in the patients over50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group(4/7cases). The over-25-year group accounted for the stromal tumors(10/12 cases).CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient's age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary.

Double-balloon enteroscopy in small bowel tumors: A Chinese single-center study

AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.

Double-balloon enteroscopy for obscure gastrointestinal bleeding: A single center experience in China

AIM: To evaluate the diagnostic value of double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding (OGIB). METHODS: The data about 75 OGIB patients who underwent DBE in January 2007-June 2009 in our hospital were retrospectively analyzed. RESULTS: DBE was successfully performed in all 75 patients without complication. Of the 75 patients, 44 (58.7%) had positive DBE findings, 22 had negative DBE findings but had potential bleeding at surgery and capsule endoscopy, etc . These 66 patients were finally diagnosed as OGIB which was most commonly caused by small bowel tumor (28.0%), angiodysplasia (18.7%) and Crohn’s disease (10.7%). Lesions occurred more frequently in proximal small bowel than in distal small bowel (49.3% vs 33.3%, P = 0.047). CONCLUSION: DBE is a safe, effective and accurate procedure for the diagnosis of OGIB.

Double-balloon enteroscopy for mesenchymal tumors of small bowel:Nine years' experience

AIM:To assess the value of double-balloon enteroscopy(DBE) for the diagnosis of gastrointestinal mesenchymal tumors(GIMTs) in the small bowel and clarify their clinical and endoscopic characteristics.METHODS:A retrospective review in a total of 783 patients who underwent a DBE procedure from January 2003 to December 2011 was conducted.Data from patients with pathologically confirmed GIMTs were analyzed at a single tertiary center with nine years' experience.The primary outcomes assessed included characteristics of patients with GIMTs,indications for DBE,overall diagnostic yield of GIMTs,endoscopic morphology,positive biopsy,comparison of diagnosis with capsule endoscopy,and subsequent interventional management.RESULTS:GIMTs were identified and analyzed in 77 patients.The mean age was 47.74 ± 14.14 years(range:20-77 years),with 63.6% being males.The majority of individuals presented with gastrointestinal bleeding,accounting for 81.8%,followed by abdominal pain,accounting for 10.4%.Small bowel pathologies were found in 71 patients,the detection rate was 92.2%.The diagnostic yield of DBE for GIMTs was 88.3%.DBE was superior to capsule endoscopy in the diagnosis of GIMTs(P = 0.006;McNemar's χ2 test).Gastrointestinal stromal tumor was the most frequent and leiomyoma was the second frequent GIMT.Single and focal lesions were typical of GIMTs,and masses with smooth or unsmooth surface were the most common in the small bowel.GIMTs were removed from all the patients surgically except one patient treated with endoscopic resection.CONCLUSION:DBE is a safe and valuable procedure for patients with suspected GIMTs,and it provides an accurate position for subsequent surgical intervention.

Hyperamylasemia is associated with increased intestinal permeability in patients undergoing diagnostic oral double-balloon enteroscopy

AIM:To investigate the correlations between serum amylase levels,intestinal permeability(IP),and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy(DBE).METHODS:A prospective study was conducted in 20patients who underwent DBE from August 1,2008 to February 28,2009.Serum amylase was examined 0,2,6 and 24 h post-DBE,C-reactive protein and lipase were examined at 24 h,and urine lactulose,mannitol,and trypsinogen-Ⅱ(TRY-Ⅱ)levels were measured at6 h.Lactulose/mannitol ratio indicated IP,and TRY-Ⅱindicated pancreatic injuries.Procedure duration and enteroscope insertion length were recorded.RESULTS:Twelve patients underwent oral DBE(M:F,5:7;mean age 50.42±11.11 years)and 8 underwent anal DBE(M:F,5:3;mean age 44.75±12.66 years).They all showed significantly increased post-DBE serum amylase.Amylase and lipase levels were higher in the oral DBE group(P<0.05).Hyperamylasemia was diagnosed in 9(75.0%)patients undergoing oral DBE.Only patients receiving oral DBE showed increased postprocedure IP,which correlated with increased serum amylase(r=0.611,P=0.035)and procedure duration(r=0.668,P=0.018).Adverse events included one oral case with pancreatic injury(elevated TRY-Ⅱ)and two cases of abdominal discomfort in each group.Pancreatitis was not reported.CONCLUSION:Hyperamylasemia correlates with increased IP and clinically undetectable pancreatic injuries.DBE could cause intestinal mucosa damage,which may result in IP elevation and increased amylase absorption,necessitating improvements and standardization of DBE methods.

Two case reports of acute upper gastrointestinal bleeding from duodenal ulcers after Roux-en-Y gastric bypass surgery: Endoscopic diagnosis and therapy by single balloon or push enteroscopy after missed diagnosis by standard esophagogastroduodenoscopy

The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.

Application of double-balloon enteroscopy in jejunal diverticular bleeding

AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.

Actively bleeding Dieulafoy's lesion of the small bowel identified by capsule endoscopy and treated by push enteroscopy

Dieulafoy 的损害是周期性的官方补给的流血的一个不平常的原因。这份报告描述活跃地为 Dieulafoy 诊断被囊内视镜检查法在做的小肠的损害放血的一个案例，与推肠寄生物的使用由治疗列在后面。案例说明那囊内视镜检查法，肠寄生物在有小肠疾病的病人是高度补足的。

Single-balloon and spiral enteroscopy may have similar diagnostic and therapeutic yields to double-balloon enteroscopy:Results from a meta-analysis of randomized controlled trials and prospective studies

BACKGROUND Double-balloon,single-balloon,and spiral enteroscopy(DBE,SBE,and SE)have revolutionized the management of intestinal diseases.However,evidence about efficacies of these methods is lacking.We aimed to conduct a meta-analysis comparing the clinical outcomes among DBE,SBE,and SE.METHODS We searched randomized controlled trials and prospective studies in MEDLINE,PubMed,EMBASE,Cochrane Library,and Chinese CQVIP database.Studies referencing the comparison of at least two of these three methods were included.Primary outcome was diagnostic yield.Other outcomes were therapeutic yield,total enteroscopy,examination time,time to maximum insertion,and depth of maximal insertion(DMI).RESULTS Eleven studies including 727 patients were identified:DBE vs SE(n=6),DBE vs SBE(n=4),and SBE vs SE(n=1).The diagnostic and therapeutic yields did not differ significantly when comparing DBE with SE[odds ratio(OR)=1.19,95%confidence interval(CI):0.68-2.08;OR=1.17,95%CI:0.61-2.23]and DBE with SBE(OR=0.85,95%CI:0.55-1.33;OR=1.71,95%CI:0.64-4.60).Total enteroscopy,examination time,time to maximum insertion,and DMI were similar between SBE and DBE.DBE was superior to SE with regard to DMI[mean difference(MD)=36.76,95%CI:5.09-68.43],with longer time to maximum insertion(MD=15.14,95%CI:12-18.27)and examination time(MD=12.98,95%CI:9.57-16.38).CONCLUSION DBE and SBE have similar clinical outcomes.Compared with DBE,SE seems to have similar diagnostic and therapeutic yields,but shorter procedural time in cost of less depth of insertion.SE needs further evaluation vs SBE.DBE is recommended for complete enteroscopy.

Comparison of double balloon enteroscopy in adults and children

AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients. METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative en-ema. The patients were followed up for 2 h after the procedure in terms of possible complications. RESULTS: DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); PeutzJeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation. CONCLUSION: With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.

为双汽球 enteroscopy 的学习曲线: 从 282 过程的分析的调查结果

AIM: To determine the learning curves for antegrade double-balloon enteroscopy (aDBE) and retrograde DBE (rDBE) by analyzing the technical success rates. METHODS: A retrospective analysis in a tertiary referral center. This study reviewed all cases from June 2006 to April 2011 with a target lesion in the small-bowel identified by either capsule endoscopy or computed tomography scan posted for DBE examinations. Main outcome measurements were: (1) Technical success of aDBE def ined by f inding or excluding a target lesion after achieving suff icient length of small bowel intubation; and (2) Technical success for rDBE was def ined by either f inding the target lesion or achieving stable overtube placement in the ileum. RESULTS: Two hundred and eighty two procedures fulf illed the inclusion criteria and were analyzed. These procedures were analyzed by blocks of 30 cases. Therewas no distinct learning curve for aDBE. Technical success rates for rDBE continued to rise over time, although on logistic regression analysis testing for trend, there was no signif icance (P = 0.09). The odds of success increased by a factor of 1.73 (95% CI: 0.93-3.22) for rDBE. For these data, it was estimated that at least 30-35 cases of rDBE under supervision were needed to achieve a good technical success of more than 75%. CONCLUSION: There was no learning curve for aDBE. Technical success continued to increase over time for rDBE, although a learning curve could not be proven statistically. Approximately 30-35 cases of rDBE will be required for stable overtube intubation in ileum.

Balloon-assisted enteroscopy for suspected Meckel's diverticulum and indefinite diagnostic imaging workup

Meckel's diverticulum(MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99 m scintigraphy(99mTc) using either labeled red blood cells or pertechnetate(known as the Meckel's scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloonassisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel's scan.

Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation:LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group).The technical success (endoscope reaching the choledochojejunostomy site),diagnostic success (performance of cholangiography),therapeutic success(completed interventions) and overall success rates,insertion and procedure(completion of DB-ERC) time,and adverse events were compared between these groups.RESULTS There were no significant differences between LO and control groups in the technical [93.3%(42/45) vs 96.6%(57/59),P=0.439],diagnostic [83.3%(35/42) vs83.6%(46/55),P=0.968],therapeutic [97.0%(32/33) vs 97.7%(43/44),P=0.836],and overall [75.6%(34/45) vs 79.7%(47/59),P=0.617] success rates.The median insertion time (22 vs 14 min,P <0.001) and procedure time (43.5 vs 30 min,P=0.033) were significantly longer in the LO group.The incidence of adverse events showed no significant difference [11.1%(5/45) vs 6.8%(4/59),P=0.670].CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required,so should be performed with particular care.

Achieving Total Enteroscopy by Consecutive Bidirectional Doubleballoon Enteroscopy Procedures

Objective:To investigate the feasibility and safety of achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy(DBE)procedures.Methods:The demographic data,indication,initial insertion route,examination time for each insertion and the entire procedure,total enteroscopy rate,diagnostic yield and adverse events of patients who attempted to achieve total enteroscopy by consecutive bidirectional DBE procedures from January 2014 to December 2019 were retrospectively analyzed.

胶囊内镜与其他小肠检查技术的比较

由于小肠解剖结构特殊,传统技术对大部分小肠的检查受到很大限制.胶囊内镜的问世填补了小肠无创性、可视化检查的空白.胶囊内镜能够直接观察全小肠黏膜,且敏感性高、安全无创,逐渐成为诊断小肠疾病的重要手段,广泛用于不明原因消化系出血、小肠克罗恩病、家族性腺瘤性息肉病等小肠疾病的诊断和监测.但是,胶囊内镜也表现出特异性不足的缺点,发现的部分异常并不具有临床意义,而且其使用前需排除小肠梗阻等情况.现就近年来胶囊内镜的应用与其他小肠检查技术进行阐述.

无外套管推进式电子小肠镜在小肠疾病诊断中的应用

目的评价无外套管推进式电子小肠镜对小肠疾病的诊断价值和安全性.方法 对1994年11月～ 2004年10月间138例疑有小肠疾病患者行推进式电子小肠镜检查,分析其应用情况.结果 138例患者中,电子小肠镜越过屈氏韧带进入空肠113例(81.9%),结果发现小肠疾病44例(31.9%),包括十二指肠多发溃疡4例,十二指肠中下段病变19例,空肠病变21例.92例不明原因消化道出血患者中,37例发现病灶,阳性检出率为41.1%.无一例出现并发症.结论 推进式电子小肠镜检查是诊断小肠疾病的有效且安全的手段之一.

34例不明原因疑小肠出血的病因诊断——推进式双气囊小肠镜与小肠钡灌检查对比研究

背景:不明原因小肠出血的病因诊断较为困难,不同检查手段的临床实用价值有待进一步探讨。目的:通过对不明原因疑小肠出血患者分别行推进式双气囊小肠镜和小肠钡灌检查,比较两者对小肠出血的病变检出率、病因诊断准确率和临床实用价值。方法:34例不明原因疑小肠出血患者分别接受推进式双气囊小肠镜和小肠钡灌检查。推进式双气囊小肠镜检查的进镜方式分为经口腔和经肛门两种,以首选进镜方式检查后未发现病灶者,择期改换进镜方式再行检查。小肠钡灌检查采用插管式稀钡灌注法。两项检查分别由消化科和放射科医师独立操作并诊断,最后进行汇总分析。结果:在34例行推进式双气囊小肠镜检查的患者中,首选从口腔进镜者22例,其中14例(63.6%)检出病灶;8例未发现病灶者择期再从肛门进镜检查,6例检出病灶。12例首选从肛门进镜者中8例(66.7%)检出病灶;4例择期再从口腔进镜检查,3例检出病灶。推进式双气囊小肠镜检查的病变整体检出率为91.2%(31/34);小肠钡灌检查的病变整体检出率为50.0%(17/34)。推进式双气囊小肠镜检查发现的阳性病灶均经活检病理检查、手术探查以及临床治疗和随访结果证实,病因诊断准确率为100%(31/31);小肠钡灌检查的病因诊断准确率为48.4%(15/31)。全麻下经口腔进镜推进式双气囊小肠镜检查的患者耐?

推进式双气囊电子小肠镜在小肠疾病诊断中的评估

目的 评价推进式双气囊电子小肠镜(double-balloon push enteroscopy,DBE)在小肠疾病诊断中的价值。方法 总结22例疑小肠疾病DBE检查的临床资料,上述患者均经胃镜、肠镜、X线钡餐、小肠钡剂灌肠和血管造影等检查未发现异常。结果 22例共行DBE检查26例次(15例次接受了口侧进镜,11例次接受了肛侧进镜),每侧进镜术程平均80 min。DBE检查共发现异常14例,检出率为63.6％。其中不明原因消化道出血10例,DBE检出病变6例;腹痛和(或)呕吐待查7例,DBE检出病变5例;慢性腹泻待查4例,DBE检出病变2例;不明原因不完全性肠梗阻1例,DBE检出病变1例。口侧进镜患者,术中多数出现恶心、消化液自口经外套管口溢出,偶尔出现一过性轻微腹痛;肛侧进镜患者无明显不适及反应,未出现出血、穿孔等并发症。结论 DBE作为一种新型小肠疾病检查手段,明显优于传统的检查方法,可重复直视操作下观察病灶,通过活检对病变进行定性检查,具有安全、可控性、直视和图像清晰等优点,在诊断小肠疾病方面更具有优越性。

推进式电子小肠镜在小肠疾病诊治中的应用价值探讨

目的评价推进式电子小肠镜在小肠疾病诊治中的应用价值。方法回顾性分析1998年3月～2006年12月在我院消化科进行推进式电子小肠镜诊治的345例患者。结果318例越过屈氏韧带，小肠检查平均检查时间为30min。144例患者诊断有小肠疾病，检出率为41．74％。28例患者行内镜下止血术，13例患者行内镜下息肉切除术。无穿孔、出血、腹痛等严重并发症发生。结论推进式电子小肠镜检查仍是目前诊断小肠疾病，尤其空肠上段以上消化道疾病有效的方法，并可进行相应治疗，安全、可靠。