AIM:To compare the diagnostic yield of capsule endoscopy (CE) with that of double-balloon enteroscopy (DBE). METHODS:Pubmed,Embase,Elsevier ScienceDirect,the China Academic Journals Full-text Database,and Cochrane Con...AIM:To compare the diagnostic yield of capsule endoscopy (CE) with that of double-balloon enteroscopy (DBE). METHODS:Pubmed,Embase,Elsevier ScienceDirect,the China Academic Journals Full-text Database,and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE. Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis. RESULTS:Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE 170/277 vs 156/277,OR 1.21 (95% CI:0.64-2.29). Based on sub analysis,the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches 137/219 vs 110/219,OR 1.67 (95% CI:1.14-2.44),P < 0.01),but not superior to the yield of DBE with combination of the two insertion approaches 26/48 vs 37/48,OR 0.33 (95% CI:0.05-2.21),P > 0.05). A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches 118/191 vs 96/191,fixed model:OR 1.61 (95% CI:1.07-2.43),P < 0.05) and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches 11/24 vs 21/24,fixed model:OR 0.12 (95% CI:0.03-0.52),P < 0.01). CONCLUSION:With combination of oral and anal approaches,the yield of DBE might be at least as high asthat of CE. Decisions made regarding the initial approach should depend on patient's physical status,technology availability,patient's preferences,and potential for therapeutic endoscopy.展开更多
AIM： To evaluate the effect of double-balloon enteros- copy （DBE） on pancreas histology and levels of pancre- atic enzymes. METHODS： Conventional upper gastrointestinal endos- copy was performed on five control pi...AIM： To evaluate the effect of double-balloon enteros- copy （DBE） on pancreas histology and levels of pancre- atic enzymes. METHODS： Conventional upper gastrointestinal endos- copy was performed on five control pigs. Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs. Two experimental groups （10 pigs each） were defined according to DBE duration： 90 rain for Group 1 and 140 min for Group 2. During oral insertion, the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla. Serum amy- lase, lipase and C-reactive protein （CRP） levels were monitored before the procedure and repeated every 30 min until the exploration was finished, as well as 24 h and 7 d after. After the procedure and for a total of 7 d, the pigs were observed twice a day for signs of de- creased activity, irritability, vomiting or anorexia. Gross and microscopic examination of the pancreas was per- formed on day 7. RESULTS： All animals tolerated DBE without clini- cal manifestations of acute pancreatitis. Experimental groups had higher levels of enzymes than the control group at 24 h. Throughout the exploration, the amylase levels increased significantly above the baseline 24 h after DBE, although the increase was not statistically significant and did not reach 20% of the baseline. An increase in lipase and CRP was observed at 24 h after the procedure, although by day 7, all enzymatic lev- els had returned to baseline. No differences between Groups 1 and 2 were found for any enzyme and sam- pling site during and after the procedure. Similarly, no correlation between insertion depth and enzyme levels was observed. Direct in situ and post-removal inspec- tion of the pancreas did not show any evidence of fluid collection, abscesses or hemorrhage. Histological examination of the pancreas from Groups 1 and 2 re- vealed the existence of focal areas （0.14-0.26 mm2） of ischemic necrosis in 47.4% of the animals. In the pigs with damaged pancreas, the left lobe （tail） was always affected. However, this only happened in 83.3% of the samples from the right lobe （head） and in 33.3% of the samples from the body of the pancreas. Significant differences were found between the left lobe （tail） and the body for the percentage of affected pancreas. Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe （tail）. The presence of the lesions was not related to the ex- ploration length.CONCLUSION： The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress.展开更多
文摘AIM:To compare the diagnostic yield of capsule endoscopy (CE) with that of double-balloon enteroscopy (DBE). METHODS:Pubmed,Embase,Elsevier ScienceDirect,the China Academic Journals Full-text Database,and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE. Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis. RESULTS:Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE 170/277 vs 156/277,OR 1.21 (95% CI:0.64-2.29). Based on sub analysis,the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches 137/219 vs 110/219,OR 1.67 (95% CI:1.14-2.44),P < 0.01),but not superior to the yield of DBE with combination of the two insertion approaches 26/48 vs 37/48,OR 0.33 (95% CI:0.05-2.21),P > 0.05). A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches 118/191 vs 96/191,fixed model:OR 1.61 (95% CI:1.07-2.43),P < 0.05) and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches 11/24 vs 21/24,fixed model:OR 0.12 (95% CI:0.03-0.52),P < 0.01). CONCLUSION:With combination of oral and anal approaches,the yield of DBE might be at least as high asthat of CE. Decisions made regarding the initial approach should depend on patient's physical status,technology availability,patient's preferences,and potential for therapeutic endoscopy.
基金Supported by PI070712 Project (Instituto de Salud Carlos Ⅲ, Ministerio de Sandiady Consumo, Spain)BIO-MED07/08-0019 Project (Consejería de Educación, Cienciae Investigación de la Región de Murcia, Spain)
文摘AIM： To evaluate the effect of double-balloon enteros- copy （DBE） on pancreas histology and levels of pancre- atic enzymes. METHODS： Conventional upper gastrointestinal endos- copy was performed on five control pigs. Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs. Two experimental groups （10 pigs each） were defined according to DBE duration： 90 rain for Group 1 and 140 min for Group 2. During oral insertion, the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla. Serum amy- lase, lipase and C-reactive protein （CRP） levels were monitored before the procedure and repeated every 30 min until the exploration was finished, as well as 24 h and 7 d after. After the procedure and for a total of 7 d, the pigs were observed twice a day for signs of de- creased activity, irritability, vomiting or anorexia. Gross and microscopic examination of the pancreas was per- formed on day 7. RESULTS： All animals tolerated DBE without clini- cal manifestations of acute pancreatitis. Experimental groups had higher levels of enzymes than the control group at 24 h. Throughout the exploration, the amylase levels increased significantly above the baseline 24 h after DBE, although the increase was not statistically significant and did not reach 20% of the baseline. An increase in lipase and CRP was observed at 24 h after the procedure, although by day 7, all enzymatic lev- els had returned to baseline. No differences between Groups 1 and 2 were found for any enzyme and sam- pling site during and after the procedure. Similarly, no correlation between insertion depth and enzyme levels was observed. Direct in situ and post-removal inspec- tion of the pancreas did not show any evidence of fluid collection, abscesses or hemorrhage. Histological examination of the pancreas from Groups 1 and 2 re- vealed the existence of focal areas （0.14-0.26 mm2） of ischemic necrosis in 47.4% of the animals. In the pigs with damaged pancreas, the left lobe （tail） was always affected. However, this only happened in 83.3% of the samples from the right lobe （head） and in 33.3% of the samples from the body of the pancreas. Significant differences were found between the left lobe （tail） and the body for the percentage of affected pancreas. Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe （tail）. The presence of the lesions was not related to the ex- ploration length.CONCLUSION： The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress.
