Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP

Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.

Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?

AIM To evaluate diagnostic yields of capsule endoscopy(CE) and/or single-balloon enteroscopy(SBE) in patients with suspected small bowel diseases.METHODS Were trospectively analyzed 700 patients with suspected small bowel diseases from September 2010 to March 2016. CE, SBE, or SBE with prior CE was performed in 401, 353, and 47 patients, respectively. Data from clinical and endoscopy records were collected for analysis. Indications, procedure times, diagnostic yields, and complications were summarized and evaluated.RESULTS The overall diagnostic yield for the CE group was 57.6%. The diagnostic yield of CE in patients with obscure gastroin testinal bleeding(OGIB) was significantly greater than that in patients with no bleeding(70.5% vs 43.8%, P < 0.01). The overall diagnostic yield of SBE was 69.7%. There was no difference in the diagnostic yield of SBE between patients with OGIB and those with no bleeding(72.5% vs 68.9%, P = 0.534). Forty-seven patients underwent CE prior to SBE. Among them, the diagnostic yield of SBE with positive findings on prior CE was 93.3%. In addition, SBE detected two cases with superficial ulcer and erosive lesions in the small bowel, which were missed by CE. However, one case with lymphoma and two with Crohn's disease were not confirmed by SBE. The rate of capsule retention was 2.0%. There were no significant complications during or after SBE examinations.CONCLUSION SBE is a safe and effective technique for diagnosing small bowel diseases. SBE with prior CE seemed to improve the diagnostic yield of small bowel diseases.

Emergent single-balloon enteroscopy for overt bleeding of small intestinal vascular malformation

A 28-year-old man presented with anemia symptoms and intermittent tarry stool passage for three days. No stigmata of hemorrhage were identified using esophagogastroduodenoscopy, ileocolonoscopy, and contrast-enhanced computed tomography. He then developed massive tarry stool passage with profound hypovolemic shock and hypoxic respiratory failure. Emergent angiography revealed active bleeder, probably from the jejunal branches of the superior mesenteric artery, but embolization was not performed due to possible subsequent extensive bowel ischemia. His airway was secured via endotracheal intubation with ventilator support, and emergent antegrade singleballoon enteroscopy was performed at 8 h after clinical overt bleeding occurrence; the procedure revealed a 2-cm pulsating subepithelial tumor with a protrudingblood plug at the distal jejunum. Laparoscopic segmental resection of the jejunum with end-to-end anastomosis was performed after emergent endoscopic tattooing localization. Pathological examination revealed a vascular malformation in the submucosa with an organizing thrombus. He was uneventfully discharged 5 d later. This case report highlights the benefit of early deep enteroscopy for the treatment of small intestinal bleeding.

Comparison between double-balloon and single-balloon enteroscopy in therapeutic ERC after Roux-en-Y entero-enteric anastomosis

AIM:To compare the efficacy of double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) in therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y entero-enteric anastomosis.METHODS:Retrospective analysis of our patient cohort revealed 4 patients with enterobiliary anastomosis and Roux-en-Y entero-enteric anastomosis who underwent repeated ERC with DBE and SBE because of recurrent cholangitis.RESULTS:A total of 38 endoscopic retrograde cholangiopancreatography procedures were performed in 25 patients with Roux-en-Y entero-enteric anastomosis.DBE was used in 29 procedures and SBE in 9.The 4 patients who underwent repeated ERC with DBE and SBE suffered from recurrent cholangitis due to stenosis of the enterobiliary anastomosis.ERC was performed repeatedly to achieve balloon dilation with/without biliary stone extraction and multiple stent placement at the level of the enterobiliary anastomosis.In all 4 patients DBE and SBE were equally successful.Compared to DBE,SBE was equally effective in passing the Roux-en-Y entero-enteric anastomosis,reaching the enterobiliary anastomosis and performing therapeutic ERC.CONCLUSION:This retrospective comparison shows that DBE and SBE are equally successful in the performance of therapeutic ERC at the level of the enterobiliary anastomosis after Roux-en-Y entero-enteric anastomosis.

Current status of single-balloon enteroscopy: Insertability and clinical applications

The single-balloon enteroscopy(SBE) system was launched in 2007, proposed as a simpler method than double-balloon enteroscopy(DBE). Controversy surrounds whether the SBE system has the same insertability as DBE. However, many methods have been proposed to improve the depth of insertion with the SBE system, involving several techniques and endoscopic accessories. SBE is used for investigating not only small bowel diseases, but also diseases of the pancreatobiliary and colonic structures. SBE is a necessary advancement for many endoscopic procedures and applications in modern clinical practice. In our review, we summarized the current literature concerning the insertability of SBE and described the technical aspects of improving the rate of deep insertion in SBE procedures. In addition, the recent applications of SBE to diseases besides those of the small bowel are described.

Evaluation of the diagnostic and therapeutic utility of retrograde through-the-scope balloon enteroscopy and single-balloon enteroscopy

BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.

ConservativeapproachinPeutz-JeghersSyndrome:Single-balloon enteroscopyandsmallbowelpolypectomy

AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in pa-tients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts(age 15-38 years) with PJS have been collected; six under-went polypectomy using single balloon enteroscopy(Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit(OBCU Olympus Balloon Control Unit) and a dispos-able silicone splinting tube with balloon(ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endos-copy(WCE). Prophylactic polypectomy was reservedmainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from-6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure.RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm(range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgi-cal resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussuscep-tions. No gastrointestinal tumors were found in sub-sequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper en-doscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps(> 15 mm).CONCLUSION: The effective of prophylactic polyp-ectomy of small bowel large polyps(> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.

Device-assisted enteroscopy: Are we ready to dismiss the spiral?

Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted enteroscopy.Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial.Following the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic yield.We conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the market.The primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue procedure.Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.

Motorized spiral enteroscopy:A cautious step forward in technological innovation

With the continuous advancement in medical technology,endoscopy has gained significant attention as a crucial diagnostic tool.The introduction of motorized spiral enteroscopy(MSE)represents a significant advancement in the diagnosis and treatment of small bowel diseases.While there are safety concerns and a high reliance on the operator’s skills,MSE should not be disregarded entirely.Instead,it should be considered as a supplementary endoscopic technique,particularly in situations where conventional endoscopy proves ineffective.Through continuous research and technical optimization,MSE has the potential to become an im-portant addition to the endoscopy toolbox in the future.We call on colleagues in the industry to work together to promote the improvement of MSE technology through continuous research and practice,with the aim to bring out its unique value in endoscopy while ensuring patient safety.

Ileal gallstone obstruction:Single-balloon enteroscopic removal

Gallstone-induced ileus is a rare complication of cholelithiasis.Since localization of gallstones impacted in the small bowel,especially in the ileum,prevents access by conventional endoscopy in most cases,the mainstay of treatment remains surgical.Recent invention of double-and single-balloon enteroscopy has added much to the ability of imaging the small bowel and enables endoscopically directed therapy.Herein,for the first time,we report a successful endoscopic calculus removal via peroral single-balloon enteroscopy in an 81-year-old woman suffering from gallstone ileus of the ileum.

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.

Computed tomography three-dimensional reconstruction in the diagnosis of bleeding small intestinal polyps:A case report

BACKGROUND Computed tomography(CT)small bowel three-dimensional(3D)reconstruction is a powerful tool for the diagnosis of small bowel disease and can clearly show the intestinal lumen and wall as well as the outside structure of the wall.The horizontal axis position can show the best adjacent intestinal tube and the lesion between the intestinal tubes,while the coronal position can show the overall view of the small bowel.The ileal end of the localization of the display of excellent,and easy to quantitative measurement of the affected intestinal segments,the sagittal position for the rectum and the pre-sacral lesions show the best,for the discovery of fistulae is also helpful.Sagittal view can show rectal and presacral lesions and is useful for fistula detection.It is suitable for the assessment of inflammatory bowel disease,such as assessment of disease severity and diagnosis and differential diagnosis of the small bowel and mesenteric space-occupying lesions as well as the judgment of small bowel obstruction points.CASE SUMMARY Bleeding caused by small intestinal polyps is often difficult to diagnose in clinical practice.This study reports a 29-year-old male patient who was admitted to the hospital with black stool and abdominal pain for 3 months.Using the combination of CT-3D reconstruction and capsule endoscopy,the condition was diagnosed correctly,and the polyps were removed using single-balloon enteroscopyendoscopic retrograde cholangiopancreatography without postoperative complications.CONCLUSION The role of CT-3D in gastrointestinal diseases was confirmed.CT-3D can assist in the diagnosis and treatment of gastrointestinal diseases in combination with capsule endoscopy and small intestinal microscopy.

Intermittent melena and refractory anemia due to jejunal cavernous lymphangioma:A case report

BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.

Characteristics and prognosis of small bowel tumors:A retrospective study

BACKGROUND Small bowel tumors(SBTs)are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5%of all gastrointestinal tumors.Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs.However,few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs.AIM To investigate the clinical characteristics,managements and prognosis of SBTs in a medical center in Taiwan.METHODS The study enrolled 51 patients aged 58.9±8.8 years(range,22-93)diagnosed with SBTs from November 2009 to July 2021.We retrospectively recorded clinical characteristics,indications,endoscopic findings,pathological results,management,and outcomes for further analysis.RESULTS A male preponderance was observed(56.8%).The most common indications were suspected small intestinal tumors(52.9%)and obscure gastrointestinal bleeding(39.2%).The most common tumor location was the ileum(41.2%).The performance of imaging studies(P=0.004)and the types of findings(P=0.005)differed significantly between malignant and benign SBTs.The most frequent imaging finding was a small intestinal mass(43.1%).The top three malignant tumor types were gastrointestinal stromal tumors(GISTs),adenocarcinomas,and lymphomas.Moreover,the proportions of benign and malignant tumors were 27.5%and 72.5%,respectively.The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly(P=0.015).Kaplan–Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups(P=0.04).All patients with lymphoma underwent chemotherapy(n=7/8,87.5%),whereas most patients with GISTs underwent surgery(n=13/14,92.8%).CONCLUSION Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs.Therefore,a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

右美托咪定辅助全身麻醉对老年无痛肠镜检查患者血流动力学及认知功能的影响

目的探讨右美托咪定(DEX)辅助全身麻醉对老年无痛肠镜检查患者血流动力学及认知功能的影响。方法将2020年7月至2022年2月在焦作市第二人民医院门诊手术室行无痛肠镜检查的老年患者180例,根据随机数字表法分为对照组(n=90)和观察组(n=90)。对照组患者给予常规全身麻醉(舒芬太尼+丙泊酚麻醉诱导,丙泊酚麻醉维持);观察组患者在术前准备后加用DEX辅助全身麻醉。比较2组患者的血流动力学指标[平均动脉压(MAP)、心率(HR)]、全麻用药量、苏醒时间、认知功能[简易精神状况检查量表(MMSE)]评分、不良反应发生率。结果2组患者麻醉前(T0)各项指标的差异均无统计学意义(P>0.05);与T0时比较,麻醉10 min后(T1)、肠镜达回盲部(T2)、检查后退镜(T3)、术后10 min(T4)时两组患者的MAP、HR均显著降低,但观察组患者在T1、T2、T3、T4时的MAP、HR均显著高于对照组(P<0.05)。与对照组比较,观察组患者的全麻用药量显著降低,苏醒时间显著缩短,术后1、2、3 d的MMSE评分显著升高,认知功能障碍发生率及不良反应发生率均显著降低(P<0.05)。结论DEX可有效改善老年无痛肠镜检查患者的血流动力学及认知功能,减少全麻用药量,缩短患者苏醒时间,且安全性较好。

疑似小肠出血患者双气囊小肠镜全小肠对接检查的临床研究

背景:双气囊小肠镜(DBE)全小肠对接检查在疑似小肠出血(SSBB)患者诊治中发挥重要作用。目的:调查SSBB患者DBE全小肠对接检查情况并分析其临床特征。方法:纳入2018年6月—2023年4月安徽省蚌埠市第三人民医院和安徽医科大学第一附属医院需行DBE对接检查的94例SSBB患者,并分析其临床特征。结果:共54例SSBB患者完成DBE全小肠对接检查,对接成功率为57.4%。因发现出血病变而中止对接检查者10例(10.6%),肠腔狭窄而中止对接检查者5例(5.3%),操作中出现进镜困难而中止对接检查者25例(26.5%)。SSBB患者DBE全小肠对接率与不同对接时间、医师既往小肠镜操作例数有关(P<0.05),而与患者性别、年龄、出血表现形式、烟酒嗜好、营养风险、腹部手术史、肛周病变、自身免疫病、术前贫血、术前白蛋白水平、进镜途径均无关(P>0.05)。ROC曲线结果显示,先进镜深度的截断值为385 cm时,评估SSBB患者完成全小肠对接检查的敏感性为72.2%,特异性为77.5%,曲线下面积为0.800(95%CI:0.705~0.875,P<0.001)。结论:SSBB患者DBE全小肠对接率与不同对接时间、医师既往小肠镜操作例数有关。先进镜深度达到385 cm以上,80%的SSBB患者有望实现全小肠对接检查。

老年病人经肛双气囊小肠镜进镜效率及其影响因素研究

目的 探讨老年病人经肛双气囊小肠镜检查(DBE)的进镜效率及影响因素。方法 纳入2022年3月至2023年10月在南京医科大学第一附属医院老年内镜中心行经肛DBE的180例60岁以上的老年病人,收集其一般资料,采用渥太华肠道准备评分(OBPS)评估病人肠道准备质量,统计经肛DBE的进镜深度及操作时间,计算进镜效率,根据进镜效率分为高效组和低效组,分析进镜效率的影响因素。结果 单因素分析显示,手术部位、息肉或憩室疾病、盲肠插管时间(CIT)与经肛DBE进镜效率相关。多因素Logistic回归分析显示,息肉等病史、手术部位及CIT是经肛DBE进镜效率的独立影响因素,有下腹部手术史的病人进镜效率较低。结论 下腹部手术史、息肉或憩室疾病、CIT长会降低老年病人经肛DBE的进镜效率。

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

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。

基于Web of Science数据库中小肠镜研究的文献计量与可视化分析

目的分析全球小肠镜领域研究现状和研究热点,为小肠镜领域相关研究提供参考依据。方法限定发表年份为“1998-2022”、语言为“English”、文献类型为“Article”,于2022年9月25日在Web of Science(WoS)数据库中采用主题词“Enteroscopy”进行检索;采用VOSviewer 1.6.17软件和文献计量在线分析平台(https://bibliometric.com)对纳入文献的发文国家、机构、作者及关键词等进行分析,并绘制相应可视化知识图谱。结果共有2204篇论著纳入分析。小肠镜领域发文量前3位的国家分别是美国、日本和中国;美国梅奥诊所(69篇)、巴黎公共医疗救助机构(62篇)、法国Udice研究型大学(62篇)占研究机构发文量前3位;小肠镜领域发文量前3位的作者分别是Yamamoto(49篇)、Nakamura(42篇)和Tanaka(40篇);Yamamoto(1688次)、Yano(1514次)和Tanaka(947次)为该领域高被引作者;关键词共现网络中胶囊内镜(出现625次)、小肠镜(出现555次)、双气囊小肠镜(出现516次)、诊断(出现424次)等为小肠镜领域高频词。结论在过去20多年中,小肠镜领域的研究发展迅猛,中国在全球小肠镜领域的地位也逐步提高。胶囊内镜和小肠镜用于小肠疾病的诊治一直是小肠镜领域的研究热点。

气囊辅助式小肠镜在诊断Meckel憩室中的应用价值

目的:探讨气囊辅助式小肠镜及其他不同检查方法对小肠Meckel憩室的诊断价值。方法:回顾性分析2010年1月—2023年12月于南京医科大学第一附属医院确诊为小肠Meckel憩室的87例患者,收集患者的一般资料、临床表现、诊断方法、治疗及病理结果等资料,总结归纳临床特征,比较气囊辅助式小肠镜与其他检查方法对小肠Meckel憩室的诊断价值。结果:87例小肠Meckel憩室患者中,55例合并消化道出血、肠梗阻、憩室炎、肠穿孔等并发症。与无并发症患者相比,伴并发症患者中位年龄较小(P=0.003),憩室直径更长[(5.2±2.6)cm vs.(3.3±1.4)cm,P=0.001],开口更宽[(2.4±1.1)cm vs.(1.6±0.7)cm,P=0.002],手术率也更高(89.1%vs.56.3%,P <0.001)。不同检查方法的诊断灵敏度分别为:气囊辅助式小肠镜94.4%,核素显像(异位胃黏膜显像)58.3%,胶囊内镜30.0%,小肠CT 9.4%,腹部CT 8.2%,数字减影血管造影0。结论:年轻患者、憩室直径长、开口宽的小肠Meckel憩室更易合并憩室炎、穿孔、出血、梗阻等并发症。气囊辅助式小肠镜对Meckel憩室的术前诊断价值最高,应作为疑诊小肠Meckel憩室患者的首选检查方法。