Innovations and techniques for balloon-enteroscopeassisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective procedure.However,further improvements in outcomes and the development of simplified procedures are required.Percutaneous treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective treatments.However,treatment should be noninvasive,effective,and safe.We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications.BEA-ERCP still requires high expertiselevel techniques and is far from a routinely performed procedure.Various techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during BEA-ERCP.The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed intestine.At present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline treatment.In this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.

Current status of device-assisted enteroscopy: Technical matters, indication, limits and complications

Enteroscopy, defined as direct visualization of the smallbowel with the use of a fiberoptic or capsule endoscopy, has progressed considerably over the past severalyears. The need for endoscopic access to improvediagnosis and treatment of small bowel disease hasled to the development of novel technologies one ofwhich is noninvasive, the video capsule, and a type of invasive technique, the deviceassisted enteroscopy.In particular, the device-assisted enteroscopy consiststhen of three different types of instruments all able toallow, in skilled hands, to display partially or throug-hout its extension (if necessary) the small intestine.Newer devices, double balloon, single balloon and spiral endoscopy, are just entering clinical use. The aim of this article is to review recent advances in small bowelenteroscopy, focusing on indications, modifications toimprove imaging and techniques, pitfalls, and clinical applications of the new instruments. With new technologies, the trials and tribulations of learning new endo-scopic skills and determining their role in the diagnosisand treatment of small bowel disease come. Identification of small bowel lesions has dramatically improved.Studies are underway to determine the best strategy toapply new enteroscopy technologies for the diagnosisand management of small bowel disease, particularly obscure bleeding. Vascular malformations such as angiectasis and small bowel neoplasms as adenocar cinomaor gas trointestinal stromal tumors. Complete entero-scopy of the small bowel is now possible. However, because of the length of the small bowel, endoscopic examination and the rapeutic maneuvers require significant skill, radiological assistance, the use of deep sedation with the assistance of the anesthetist. Prospective ran-domized studies are needed to guide diagnostic testing and the rapy with these new endoscopic techniques.

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.

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.

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。

气囊辅助小肠镜治疗Peutz-Jeghers综合征的临床价值

目的探讨气囊辅助小肠镜治疗Peutz-Jeghers综合征(Peutz-Jeghers syndrome,PJS)患者小肠息肉的临床价值与安全性。方法回顾性分析2006年6月-2014年3月在北京军区总医院就诊并行气囊辅助小肠镜下息肉切除术的28例PJS住院患者的临床资料。结果 28例患者共行气囊辅助小肠镜下息肉切除术44例次,其中经口进镜28例次,经肛进镜16例次。1例小肠息肉呈密切分布,给予腹腔镜联合小肠镜切除息肉。17例患者小肠镜前行术前检查,其中6例行小肠钡餐造影检查,11例行小肠仿真CT检查。术前检查组单次切除息肉数高于未检查组。术后出现并发症3例次(消化道出血1例次,术中穿孔2例次),并发症发生率6.8%。结论气囊辅助小肠镜下切除小肠息肉治疗PJS安全有效。术前检查有助于小肠镜进镜方式的选择。对于息肉密集分布患者,单纯镜下切除困难,可内镜联合腹腔镜治疗,一次大量切除小肠息肉,达到较好的治疗效果。

气囊辅助小肠镜对Peutz-Jeghers综合征患者小肠息肉治疗的安全性评价

目的:客观评价气囊辅助小肠镜(balloon assisted enteroscopy,BAE)镜下切除PeutzJeghers综合征(Peutz-Jeghers syndrome,PJS)患者小肠息肉临床应用的安全性.方法:回顾性总结中国人民解放军空军总医院2004-04/2014-07应用BAE对181例PJS患者小肠息肉的内镜治疗情况,重点客观分析相关的并发症发生情况.结果:181例PJS患者(男101例,女80例)共进行了483例次BAE检查及治疗(经口285次,经肛198次),行BAE圈套切除小肠息肉共2680枚,B A E息肉切除术后一过性的轻微腹痛及/或腹部不适的发生率83.2%(397/483),穿孔的发生率1.4%(7/483),术中出血发生率10.1%(49/483),术后出血发生率1.9%(9/483),术后并发急性胰腺炎1例,无内镜治疗相关的死亡病例.结论:BAE治疗PJS患者小肠息肉尽管有一定风险和技术难度,但总体上并发症发生率较低,值得临床推广应用.

早期小肠镜干预对Peutz-Jeghers综合征患者的影响

目的明确早期气囊辅助内镜(小肠镜)干预对Peutz-Jeghers综合征(Peutz-Jeghers syndrome,PJS)患者的影响。方法回顾性分析2008年1月—2018年1月期间于空军特色医学中心(原空军总医院)行小肠镜下治疗的PJS患者为研究对象(284例),将其按是否因该疾病行外科手术治疗分为外科手术组(198例)和非外科手术组(86例),分别以"首次小肠镜干预年龄是否14岁以下"和"有无家族史"为暴露因素,对2组患者进行病例对照研究。结果 14岁前首次行小肠镜治疗较14岁后对PJS患者行外科手术治疗有统计学意义(χ~2=16.277,P<0.05),14岁前行小肠镜干预起保护性作用,可降低PJS患者外科手术治疗风险[OR=0.297,95%CI(0.164～0.535)]。有无家族史对PJS患者是否行外科手术治疗差异有统计学意义(χ~2=7.329,P<0.05),有家族遗传史者外科手术风险较散发者低,家族史起保护性作用,降低了PJS患者外科手术风险[OR=0.485,95%CI(0.287～0.818)]。14岁前小肠镜干预和家族史这两个变量无明显关联性(χ~2=3.672,P>0.05)。结论 Peutz-Jeghers综合征患者行早期小肠镜干预可以有效降低外科手术风险。

First report of splenic rupture following deep enteroscopy

Splenic rupture is a rare complication of diagnostic and therapeutic gastrointestinal endoscopy procedures.Herein,we report for the first time a case of splenic rupture following therapeutic retrograde double-balloon enteroscopy,which occurred in an 85-year-old man who was treated for recurrent mid-intestinal bleeding that resulted from ileal angioectasia.This patient promptly underwent an operation and eventually recovered.

Small intestinal hemolymphangioma treated with enteroscopic injection sclerotherapy: A case report and review of literature

BACKGROUND Hemolymphangiomas are rare malformations composed of both lymphatic and vascular vessels and are located in the pancreas,spleen,mediastinum,etc.Small intestinal hemolymphangioma is extremely rare and often presents as obscure gastrointestinal bleeding.It is rarely diagnosed correctly before the operation.Endoscopic injection sclerotherapy is usually used as a management of bleeding in esophageal varices and was occasionally reported as a treatment of vascular malformation.The treatment of small intestinal hemolymphangioma with enteroscopic injection sclerotherapy has not been reported.CASE SUMMARY A 42-year-old male complained of recurrent episodes of melena and dizziness,fatigue and reduced exercise capacity for more than 2 mo.Gastroduodenoscopy and blood test revealed a gastric ulcer and anemia.Treatment with oral protonpump inhibitors and iron did not improve symptoms.We then performed a capsule endoscopy and anterograde balloon-assisted enteroscopy and revealed a hemolymphangioma.Considering it is a benign tumor without malignant potential,we performed enteroscopic injection sclerotherapy.He was discharged 4 days later.At follow-up 3 mo later,the melena disappeared.Balloon-assisted enteroscopy revealed an atrophied tumor atrophied and no bleeding.Argon plasma coagulation was applied to the surface of the hemolymphangioma to accelerated healing.When he returned for follow-up 1 year later,anemia was resolved and the tumor had been cured.CONCLUSION Balloon-assisted enteroscopy and capsule endoscopy are effective methods for diagnosis of hemolymphangioma.Enteroscopic injection sclerotherapy is an effective treatment.

Peutz-Jeghers综合征发病机制及临床诊治研究进展

Peutz-Jeghers综合征(peutz-jeghers syndrome, PJS)是一种常染色体显性遗传疾病,目前已被证实的致病基因为STK11.该病的特征性表现为皮肤黏膜色素斑、消化道多发错构瘤性息肉及肿瘤易感性.基于目前研究报道, STK11胚系突变可能通过干扰正常的细胞凋亡、细胞分裂G1期阻滞、细胞极化及细胞间质水平的细胞增殖抑制等导致了PJS消化道息肉及恶性肿瘤的发生.治疗消化道息肉及息肉相关并发症是干预该病的主要手段.近年来,气囊辅助小肠镜治疗PJS小肠息肉经验不断积累、安全性得到了充分认可,使得大部分患者避免了外科开腹手术,这对改善了患者生活质量及远期预后有重要意义.另外,针对PJS随年龄增长消化道息肉生长特点及显著增加消化道及非消化道恶性肿瘤风险,我们按照年龄阶段进行有差别有针对的随访策略.

气囊辅助小肠镜治疗Peutz-Jeghers综合征小肠息肉肠套叠的临床探讨

目的评估气囊辅助小肠镜(BAE)治疗Peutz-Jeghers综合征小肠息肉(PJP)肠套叠的有效性及安全性,探讨影响PJP肠套叠治疗方式选择的因素。方法收集2013年1月-2019年6月就诊于空军特色医学中心的PJP肠套叠患者的临床资料,按照纳入、排除标准,最终48例符合要求的患者入选,男女比例为28∶20,平均年龄(20.6±9.2)岁,统计PJP肠套叠患者BAE的治疗成功率、术后并发症发生率,并应用病例对照研究的方法,比较BAE治疗成功组与最终外科手术治疗组患者的年龄、性别、外科手术史、临床症状、套叠息肉直径、套叠数量、最长单个套叠长度等临床资料。结果BAE治疗PJP肠套叠的总体有效率为83.3%(35/42),术后并发症发生率为2.4%(1/42)。将35例BAE治疗成功者归为小肠镜组,将13例接受外科手术治疗者归为外科组,2组性别、手术史、PJS家族史、导致肠套叠的息肉平均直径及术中发现息肉数量比较差异均无统计学意义,小肠镜组平均年龄小于外科组、临床症状无或轻者比例高于外科组,套叠数量少于外科组,套叠长度短于外科组,差异均有统计学意义(P<0.05或P<0.01)。结论BAE治疗PJP肠套叠总体安全、有效,可作为PJP肠套叠且不伴完全性肠梗阻患者的首选治疗方案。

Enteroscopy in children and adults with inflammatory bowel disease

Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB)in about 30%of the patients,especially in the young ones.Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up.The introduction of cross-sectional imaging techniques and capsule endoscopy(CE)have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa.The main CE limitations are the low specificity,the lack of therapeutic capabilities and the impossibility to take biopsies.Device assisted enteroscopy(DAE)enables histological confirmation when traditional endoscopy,capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation,intralesional steroid injection,capsule retrieval and more recently stent insertion.In the current review we will discuss technical aspect,indications and safety profile of DAE in children and adults with IBD.

Treatment of gastrointestinal bleeding in left ventricular assist devices:A comprehensive review

Left ventricular assist devices(LVAD)are increasingly become common as life prolonging therapy in patients with advanced heart failure.Current devices are now used as definitive treatment in some patients given the improved durability of continuous flow pumps.Unfortunately,continuous flow LVADs are fraught with complications such as gastrointestinal(GI)bleeding that are primarily attributed to the formation of arteriovenous malformations.With frequent GI bleeding,antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening events.Small bowel bleeds account for 15%as the source and patients often undergo multiple endoscopic procedures.Treatment strategies include resuscitative measures and endoscopic therapies.Medical treatment is with octreotide.Novel treatment options include thalidomide,angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers,estrogen-based hormonal therapies,doxycycline,desmopressin and bevacizumab.Current research has explored the mechanism of frequent GI bleeds in this population,including destruction of von Willebrand factor,upregulation of tissue factor,vascular endothelial growth factor,tumor necrosis factor-α,tumor growth factor-β,and angiopoetin-2,and downregulation of angiopoetin-1.In addition,healthcare resource utilization is only increasing in this patient population with higher admissions,readmissions,blood product utilization,and endoscopy.While some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages,these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.

Enteroscopy in small bowel Crohn's disease: A review

Crohn's disease(CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel.Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist,aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy(WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy(DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy(DBE), single balloon enteroscopy(SBE) and more recently spiral enteroscopy(SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn's. These excluded topics already have comprehensive reviews.Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D(based on expert opinion).The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial's in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.

气囊辅助小肠镜在小肠疾病治疗中的应用

本述评以气囊辅助小肠镜在小肠疾病治疗中的应用为主要内容,重点阐述气囊辅助小肠镜在小肠出血、小肠良性狭窄、小肠良性肿瘤、恶性小肠梗阻、小肠异物滞留五个方面的应用,分别涉及到小肠镜下硬化注射、氩离子凝固术、金属夹夹闭;小肠镜下球囊扩张、狭窄切开;小肠镜下黏膜切除术、小肠镜下黏膜下剥离术、小肠镜下全层切除术;小肠镜下自膨式金属支架置入术以及小肠镜下异物取出术等多项小肠镜治疗技术.

小肠重度狭窄的预测因素分析

目的 严重的小肠狭窄可不出现易于识别的肠梗阻,易导致胶囊内镜检查中胶囊滞留。本研究拟探讨小肠重度 狭窄的预测因素,帮助降低胶囊内镜检查的滞留风险。方法 回顾空军特色医学中心2012年9月1日 2018年10月31日完成 的诊断性气囊辅助小肠镜(balloon-assisted enteroscopy,BAE)住院患者,有59例。根据BAE检查中所见将小肠狭窄分为 重度狭窄(小肠镜镜身不可通过)和非重度狭窄(小肠镜可见明显狭窄且镜身可顺利通过)2组。分析小肠重度狭窄与性别、 年龄、症状性梗阻、消化道出血、腹部CT/MRI提示狭窄、病因诊断、开腹手术史、体型等的相关性,并通过分析明确小肠重 度狭窄的独立预测因素。结果 纳入的59例BAE小肠狭窄的患者中36例为重度狭窄者、23例为非重度狭窄者。消化道出血 (P= 0.015)、高血压病史(P=0.024)及腹部CT/MRI提示狭窄(P=0.040)与小肠重度狭窄具有显著相关性;症状性梗阻、年 龄>60岁、男性、狭窄病因、体型和开腹手术史等与小肠重度狭窄无显著相关性(P>0.05)。多因素分析显示显性消化道出血 是小肠重度狭窄的独立保护因素(P=0.022)。结论 显性消化道出血是小肠重度狭窄的独立保护因素。腹部CT/MRI提示小 肠狭窄或梗阻与小肠重度狭窄具有显著相关性;无小肠症状性梗阻不足以除外小肠重度狭窄,对无梗阻症状患者行胶囊内镜 检查有风险。

气囊辅助小肠镜对不明原因消化道出血的诊断和治疗价值

背景:不明原因消化道出血(OGIB)的诊治是临床一大难题,气囊辅助小肠镜(BAE)对OGIB的诊断具有独到优势。目的:探讨BAE对OGIB的诊断和治疗价值。方法:收集2009年1月—2015年3月中国人民解放军空军总医院诊断为OGIB并接受BAE检查的患者124例,回顾性分析入选者的BAE诊断结果、治疗、随访、并发症等。对双气囊小肠镜(DBE)、单气囊小肠镜(SBE)经口、经肛检查进行比较。对BAE与胶囊内镜(CE)、消化道钡剂造影、血管造影的诊断效率进行比较。结果:DBE与SBE经口、经肛检查的进镜深度、进镜时间以及阳性检出率差异均无统计学意义(P>0.05)。BAE、CE、消化道钡剂造影、血管造影的阳性检出率分别为68.5%(85/124)、51.1%(24/47)、38.1%(8/21)以及21.4%(3/14),BAE的阳性检出率显著高于CE、消化道钡剂造影以及血管造影(P<0.05)。BAE、CE、消化道钡剂造影以及血管造影的特异性分别为97.5%、62.5%、54.5%以及66.7%,敏感性分别为100%、65.2%、30.0%以及12.5%,BAE的特异性和敏感性均显著高于CE、消化道钡剂造影以及血管造影(P<0.05)。23例患者行BAE镜下治疗,治疗后出血均停止。124例患者均完成BAE检查,无并发症发生。结论:BAE是一项安全、有效的诊断和治疗OGIB的方法。

气囊辅助内镜在小肠肿瘤诊治中的应用价值

目的研究气囊辅助内镜(BAE)在小肠肿瘤诊治中的应用价值。方法收集我院2007年5月-2014年9月收治的126例临床疑似小肠肿瘤并行BAE检查的患者,其中80例患者同时行腹部CT检查,22例患者同时行消化道钡剂造影检查,24例患者同时行胶囊内镜检查。比较不同检查方法对小肠肿瘤阳性检出率、特异性、敏感性、漏诊率、误诊率等方面的差异。部分患者行BAE镜下治疗并评价其安全性及可行性。结果 BAE对于小肠肿瘤的阳性检出率为92.9%,明显高于腹部CT(47.5%)和消化道钡剂造影(68.2%),但与胶囊内镜(91.7%)比较差异无统计学意义(P>0.05)。BAE与胶囊内镜检查小肠肿瘤的敏感性均为100%,明显高于腹部CT(71.1%)和消化道钡剂造影(66.7%,P<0.01)。BAE检查小肠肿瘤的特异性为100%,明显高于腹部CT(82.9%)、消化道钡剂造影(28.6%)及胶囊内镜(22.2%,P<0.01)。BAE检查与胶囊内镜检查的漏诊率均为0,与腹部CT(28.9%)、消化道钡剂造影(33.3%)比较明显降低(P<0.01)。本组病例中,BAE检查未发现误诊病例,腹部CT误诊率为17.1%,消化道钡剂造影误诊率为71.4%,胶囊内镜误诊率为77.8%,BAE误诊率较腹部CT、消化道钡剂造影、胶囊内镜明显降低(P<0.01)。BAE可对部分小肠肿瘤患者进行镜下治疗。结论BAE检查对小肠肿瘤具有较高的阳性检出率、敏感性及特异性,且对于部分小肠肿瘤的内镜下治疗安全、可靠,具有较高的临床应用价值。

不明原因消化道出血的临床特点对气囊辅助小肠镜进镜路径选择的指导意义

目的探讨不明原因消化道出血临床特点对指导选择气囊辅助小肠镜进镜途径的作用和临床意义。方法回顾性分析空军总医院2003年9月—2015年3月因不明原因消化道出血(obscure gastrointestinal bleeding,OGIB)行气囊辅助小肠镜(balloon assisted enteroscopy,BAE)检查的222例住院患者临床资料,按进镜途径的不同,分为经口进镜组和经肛进镜组,比较分析2组患者的临床特点、BAE检查结果和并发症。结果接受BAE检查的222例OGIB患者中,130例发现病变,病变总检出率为58.56%(130/222)。结果显示,临床表现以黑便为主者,尤其首次大便为柏油样黑便者选择经口进镜病变检出率明显高于经肛进镜;而以暗红色血便或鲜血便为主者,经肛进镜较经口进镜病变检出率高,二者差异有统计学意义(P<0.05)。结论对于OGIB患者行BAE检查前,依据大便颜色改变情况选择进镜途径,可有效提高单侧进镜发现小肠出血病变的检出率。