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中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (09) : 948 -954. doi: 10.3877/cma.j.issn.1674-0785.2023.09.004

临床研究

1108例小肠疾病的临床诊断及检查策略分析
邱春华, 张志宏()   
  1. 610072 成都,四川省医学科学院 四川省人民医院消化内科
  • 收稿日期:2023-04-16 出版日期:2023-09-15
  • 通信作者: 张志宏
  • 基金资助:
    四川省科技厅重点研发项目资助(2023YFS0198)

Clinical diagnosis and examination strategy for small intestinal diseases: analysis of 1108 cases

Chunhua Qiu, Zhihong Zhang()   

  1. Department of Gastroenterology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610072, China
  • Received:2023-04-16 Published:2023-09-15
  • Corresponding author: Zhihong Zhang
引用本文:

邱春华, 张志宏. 1108例小肠疾病的临床诊断及检查策略分析[J]. 中华临床医师杂志(电子版), 2023, 17(09): 948-954.

Chunhua Qiu, Zhihong Zhang. Clinical diagnosis and examination strategy for small intestinal diseases: analysis of 1108 cases[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(09): 948-954.

目的

回顾性分析小肠疾病的临床表现和组成类型,探讨针对小肠疾病如何有效合理应用胶囊内镜(VCE)、双气囊小肠镜(DBE)、计算机断层扫描肠成像(CTE)检查,以提高小肠疾病的诊断率。

方法

2015年1月至2022年6月在四川省医学科学院•四川省人民医院考虑小肠疾病进行VCE、DBE、CTE检查至少其中一项及多项的受检者1108例,其中VCE368例、DBE361例、CTE379例,进行回顾性分析。

结果

全小肠检查完成率VCE为93.75%,与DBE比较有明显差异(P<0.01),两者在病变检出率、病因诊断率均有较高的比例。对不明原因的腹痛患者,医生和患者更多选择先做VCE检查。而对怀疑及诊断克罗恩病的患者,因担心胶囊滞留的风险,更多选择了DBE检查。VCE在炎症糜烂、血管畸形、血管显露、淋巴管扩张的诊断率明显高于DBE(P<0.01)。DBE在溃疡、腺癌、憩室、血管瘤的诊断率明显高于VCE(P<0.01)。DBE在克罗恩病、间质瘤的诊断有优势(P<0.05)。随着小肠检查从VCE、DBE、CTE单一检查到三项检查的使用,小肠疾病的病因诊断率不断提高达到87.01%。尤其是进行上述三项检查与只做DBE检查比较,诊断率从72.30%提高到87.01%,差异有统计学意义(P<0.01)。

结论

针对不同疾病,VCE、DBE、CTE检查各有优势。对不同的患者有针对性的选择合适的小肠检查方法,采取优化的联合序贯检查策略,合适的检查时机,良好的肠道准备,均可以提高疾病诊断水平,和检查的性价比,减少并发症的发生。

Objective

To retrospectively analyze the clinical manifestation and type of small intestinal diseases, and to explore how to improve the diagnostic rate of small intestinal diseases by effectively using capsule endoscopy(VCE), double-balloon enteroscopy (DBE), and computed tomoimagedata enterography (CTE).

Methods

From January 2015 to June 2022, 1108 patients underwent small intestinal examination at Academy of Medical Sciences & Sichuan Provincial People's Hospital. These included 368, 361, and 379 cases who underwent VCE, DBE, and CTE, respectively.

Results

The completion rate of small intestine examination by VCE was 93.75%, which was significantly different from that by DBE (P<0.01). However, both of them had a high detection rate of lesions and diagnosis rate of etiology. The diagnostic rates of inflammatory erosion, vascular malformation, vascular exposure, and lymphatic dilatation by VCE were significantly higher than those by DBE (P<0.01). The diagnostic rates of ulcer, adenocarcinoma, diverticulum, and hemangioma by DBE were significantly higher than those by VCE (P<0.01). DBE has advantages in the diagnosis of Crohn's disease and stromal tumors (P<0.05). When all the three examinations were combined, the diagnosis rate of small intestinal diseases increased to 87.01%; compared with the diagnosis rate by DBE, the difference was statistically significant (P<0.01).

Conclusion

VCE, DBE, and CTE have their own advantages in detecting different diseases. Appropriate small intestine examination, application of optimized combined sequential examination strategy, suitable testing time, and good bowel preparation can improve the level of diagnosis, raise the cost performance of examination, and decrease the incidence rate of complications.

表1 小肠检查完成情况(%)
表2 不同症状的患者进行小肠检查的情况[例(%)]
表3 三种检查方法的小肠疾病诊断率(%)
表4 不同检查对小肠疾病的病因诊断率(%)
1
Soncini M, Girelli CM, Franchis R, et al. Small-bowel capsule endoscopy in clinical practice: has anything changed over 13 years? [J]. Dig Dis Sci, 2018, 63(9): 2244-2250.
2
Kameda N, Higuchi K, Shiba M, et al. A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding [J]. J Gastroenterol, 2008, 43: 434-440.
3
Kim SH, Lim YJ, Park J, et al. Changes in performance of small bowel capsule endoscopy based on nationwide data from a Korean Capsule Endoscopy Registry [J]. Korean J Intern Med, 2020, 35: 889-896.
4
Tennyson CA, Semrad CE. Advances in small bowel imaging [J]. Curr Gastroenterol Rep, 2011, 13: 408-417.
5
May A. Double-balloon enteroscopy [J]. Gastrointest Endosc Clin N Am, 2017,27(1):113-122.
6
Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) technical review [J]. Endoscopy, 2018, 50(4): 423-446.
7
Zhang Q, He Q, Liu J, et al. Combined use of capsule endoscopy and double-balloon enteroscopy in the diagnosis of obscure gastrointestinal bleeding: meta-analysis and pooled analysis [J]. Hepato-Gastroenterology, 2013, 60: 1885-1891.
8
Gross SA, Stark ME. Initial experience with double-balloon enteroscopy at a U.S. center [J]. Gastrointest Endosc, 2008,67: 890-897.
9
Otani K, Watanabe T, Shimada S, et al. Clinical utility of capsule endoscopy and duble-balloon enteroscopy in the management of obscure gastrointestinal bleeding [J]. Digestion, 2018, 97: 52-58.
10
ACG Clinical Guideline: Diagnosis and management of small bowel bleeding [J]. Am J Gastroenterol, 2015, 110: 1265-1287.
11
Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline [J]. Endoscopy, 2015, 47(4): 352-376.
12
国家消化系统疾病临床医学研究中心(上海), 国家消化内镜质控中心, 中华医学会消化内镜学分会胶囊内镜协作组, 等. 中国小肠胶囊内镜临床应用指南(2021, 上海) [J]. 中华消化内镜杂志, 2021, 38(8): 589-614.
13
Chen X, Ran ZH, Tong JL. A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases [J]. World J Gastroenterol, 2007, 13(32): 4372-4378.
14
Kuo JR, Pasha SF, Leighton JA. The clinician's guide to suspected small bowel bleeding [J]. Am J Gastroenterol, 2019, 114(4):591-598.
15
Limsrivilai J, Srisajjakul S, Pongprasobchai S, et al.A prospective blinded comparison of video capsule endoscopy versus computed tomography enterography in potential small bowel bleeding: clinical utility of computed tomography enterography [J]. J Clin Gastroenterol, 2017, 51(7): 611-618.
16
Simone FD, Machado P, Calderon EG. Diagnostic and therapeutic approach to small bowel disorders through capsule endoscopy and double-balloon endoscopy [J]. Rev Gastroenterol Peru, 2017, 37(1): 58-64.
17
Teshima CW, Kuipers EJ, Zanten SV, et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis [J]. J Gastroenterol Hepatol, 2011, 26: 796-801.
18
Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding [J]. Gastrointest Endosc, 2008, 68: 920-936.
19
戈之铮. 整合小肠疾病内镜诊断技术资源势在必行 [J]. 中华消化内镜杂, 2010, 27(8): 393-395.
20
Melmed GY, Dubinsky MC, Rubin DT, et al.Utility of video capsule endoscopy for longitudinal monitoring of Crohn's disease activity in the small bowel: a prospective study [J]. Gastrointest Endosc, 2018, 88(6): 947-955.
21
Ribeiro I, Pinho R, Rodrigues A, et al.The importance of alternative diagnostic modalities in the diagnosis of small bowel tumors after a negative capsule endoscopy [J]. GE Port J Gastroenterol, 2015, 22(3): 112-116.
22
中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年北京) [J]. 中华炎性肠病杂志, 2018, 2(3): 173-190.
23
Allocca M, Fiorino G, Bonifacio C, et al. Noninvasive multimodal methods to differentiate inflamed vs fibrotic strictures in patients with Crohn's Disease [J]. Clin Gastroenterol Hepatol, 2019, 62(186): 6152-6163.
24
Agrawal JR,Travis AC, Mortele KJ, et al. Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy [J]. J Gastroenterol Hepatol, 2012, 27(4): 751-759.
25
Heo HM, Park CH, Lim JS, et al. The role of capsule endoscopy after negative CT enterography in patients with obscure gastrointestinal bleeding [J]. Eur Radiol, 2012, 22(6): 1159-1166.
26
齐诗蕊, 陈俊, 潘飞, 等. 北京市三级医院小肠疾病诊治现状 [J]. 首都医科大学学报, 2017, 38(2): 295-298.
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