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急性胶囊肠镜检查对不明原因的严重胃肠道出血的诊断率和影响

发布日期:2014-1-29 12:40:30 文章来源:Endoscopy 作者次数:1264
    急性胶囊肠镜检查对不明原因的严重胃肠道出血的诊断率和影响

    S. Lecleire, I. Iwanicki-Caron, A. Di-Fiore, C. Elie, R. Alhameedi, S. Ramirez, S. Hervé, E. Ben-Soussan, P. Ducrotté, M. Antonietti

    法国鲁昂医院大学消化内科消化内镜组

    背景和研究目的:不明原因胃肠道出血(ODGIB)患者是通过显性出血与阴性上下消化道内镜检查结果确定的。目前,急诊胶囊肠镜检查在患者体内的置入点尚未明确。该研究目的是评估急诊胶囊肠镜检查的诊断率以及其对不明原因的严重胃肠道出血(ODGIB)患者进一步管理的影响。

    患者和方法:2003年至2010年期间,我们采用回顾性的方式将所有接受过急诊胶囊肠镜检查术的不明原因的严重胃肠道出血(ODGIB)患者纳入随后的24-48h的阴性急诊上下消化道内镜检查中。严重的OOGIB是通过具有血流动力学不稳定性的进行性出血和/或大量输入红血球的需要所确定的。

    结果:在我们胃肠出血组住院的5744例患者中,55%1%)的患者出现严重OOGIB,并接受了急诊胶囊肠镜。胶囊肠镜检查发现41例患者发生出血(75%),而且发现37例患者出现病变(67%)。同时检查结果还发现19例患者(35%)患有小肠血管发育不良,7例(13%)有溃疡,5例(9%)有肿瘤,2例(3%)小肠静脉曲张,4例(7%)盲肠血管发育不良,12例(22%)患者小肠出现新鲜血液,而且无确定性病变。对78%的患者进行具体诊断和治疗程序。进一步管理包括内镜检查术(54%),外科手术(22%)和放射学(2%)。

    结论:急诊胶囊肠镜发现67例严重OOGIB患者出现出血病变。急诊胶囊肠镜看起来是一种很有前途的诊断手段,并对严重OOGIB患者临床管理有着后续影响。

     

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    Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding

    S. Lecleire, I. Iwanicki-Caron, A. Di-Fiore, C. Elie, R. Alhameedi, S. Ramirez, S. Hervé, E. Ben-Soussan, P. Ducrotté, M. Antonietti

    Digestive Endoscopy Unit, Gastroenterology Department, Rouen University Hospital,France

    Background and study aims: Patients with obscure-overt gastrointestinal bleeding (OOGIB) are defined by overt hemorrhage and negative upper and lower endoscopy findings. At present, the place of emergency capsule enteroscopy in patients with severe OOGIB is unknown. The aim of this study was to assess the diagnostic yield and the impact of emergency capsule enteroscopy on further management in patients with severe OOGIB.

    Patients and methods: Between 2003 and 2010, we retrospectively included all patients with severe OOGIB who underwent emergency capsule enteroscopy in the 24 - 48 h following negative urgent upper and lower endoscopy. Severe OOGIB was defined by ongoing bleeding with hemodynamic instability and/or the need for significant red blood cell transfusion.

    Results: Out of 5744 patients hospitalized in our Gastrointestinal Bleeding Unit, 55 (1 %) presented with severe OOGIB and underwent emergency capsule enteroscopy. Capsule enteroscopy showed blood in 41 patients (75 %) and lesions in 37 patients (67 %). Findings included small bowel angiodysplasia in 19 patients (35 %), ulcers in 7 (13 %), tumors in 5 (9 %), small-bowel varices in 2 (3 %), cecum angiodysplasia in 4 (7 %), fresh blood in small bowel without identified lesion in 12 (22 %). Specific diagnostic and therapeutic procedures were undertaken in 78 % of patients. Further management included endoscopy (54 %), surgery (22 %), and radiology (2 %).

    Conclusions: Emergency capsule enteroscopy identified bleeding lesions in 67 % of patients with severe OOGIB. Emergency capsule enteroscopy seems to be a promising diagnostic tool with a subsequent impact on clinical management in patients with severe OOGIB.

     

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