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胃肠出血检查中的检测顺序

发布日期:2014-1-29 12:40:35 文章来源:Endoscopy 作者次数:1196
    胃肠出血检查中的检测顺序

    A. Sonnenberg

    美国俄勒冈州波特兰VA医疗中心和俄勒冈卫生科学大学

    背景和研究目的:诊断与治疗疑似消化道出血的检测方法有很多种。本研究的目的是探讨哪种测试序列应该用于处理消化道出血。

    方法:对于每个内镜检查、放射学或实验室检测程序,估计专业费用和设备成本的依据是2010年财政年期间美国医疗保险和医疗补助服务中心所允许的支出。运用阈值分析比较不同临床治疗方案相对应的测试序列的相关费用。

    结果:阈值表示预期的最低成功概率,对此测试将会说明。在一种囊括所有可能的检查方法的病情检查中,与实验室测试和洗胃相关的阈值为1%,同时与食管胃十二指肠镜检、结肠镜检查、核扫描、肠镜检、计算机断层扫描(CT)造影、胶囊内镜以及血管造影联合导管栓塞相关的阈值分别为8 %9 %9 %11 %14 %23 %25 %。不同临床情况需计算各自的阈值。在大多数情况下,食管胃十二指肠镜检与结肠镜检查的阈值仍比较低。在灵敏度分析中,并发症或手术成本上升的风险也导致其阈值的增加,这可能使特定手术无法立足。

    结论:较低的阈值表示着一个首选的测试方法,它应该用于一系列多个可能检查顺序中的早期而不是晚期,以此检查胃肠出血病例。

     

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    Test sequence in the management of gastrointestinal bleeding

    A. Sonnenberg

    Portland VAMedicalCenterandOregonHealth & ScienceUniversity,Portland,Oregon,USA

    Background and study aim: A large variety of test procedures is available to diagnose and treat patients with suspected gastrointestinal bleeding. The aim of the study was to investigate which test sequence should be utilized in managing gastrointestinal bleeding.

    Methods: For each endoscopic, radiologic, or laboratory test procedure, professional fees and facility costs were estimated based on payments allowed by the US Centers for Medicare and Medicaid Services during the fiscal year 2010. A threshold analysis was used to compare the costs associated with different test sequences of varying clinical scenarios.

    Results: A threshold represents the lowest expected probability of success, for which a test would still be indicated. In a work-up including all possible management options, the threshold associated with laboratory tests and gastric lavage was 1 %, esophagogastroduodenoscopy (EGD) 8 %, colonoscopy 9 %, nuclear scan 9 %, enteroscopy 11 %, computed tomography (CT) angiography 14 %, capsule endoscopy 23 %, and angiography with transcatheter embolization 25 %. Varying sets of thresholds were calculated for different clinical scenarios. The thresholds of EGD and colonoscopy remained low in most scenarios. In sensitivity analysis, rising risk of complications or costs of a procedure also lead to rising threshold values for it, potentially rendering the particular procedure untenable.

    Conclusions: A low threshold indicated a preferred management option that should be used early rather than late in a sequence of multiple possible test procedures to work up instances of gastrointestinal bleeding.

     

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