Taylor A C, Chen R Y, Desmond P V
Gastroenterology Dept., St Vincent's Hospital, Melbourne, Australia.
Endoscopy. 2001 Mar;33(3):227-30. doi: 10.1055/s-2001-12799.
Although a stiffening overtube is commonly used with push enteroscopy, in the belief that this will allow increased insertion into the small intestine, there is no prospective data to support this view. The aim of this study is to prospectively study the depth of insertion into the small intestine at enteroscopy with and without an overtube.
A total of 38 patients referred for enteroscopy were prospectively studied. Alternate enteroscopies were performed with or without an overtube; therefore 19 patients had enteroscopy with and 19 without an overtube. The groups were well matched for age, sex, indication, use of fluoroscopy, and dedicated anesthetic assistance. Depth of insertion was assessed by advancing the enteroscope as far as possible, then straightening the enteroscope until the tip began withdrawing. The difference between the straightened insertion depth and the distance from the incisors to the pylorus was recorded as the insertion depth beyond the pylorus. This was considered the major end point. Statistical analysis was performed using the Mann-Whitney test for nonparametric data.
The median straightened total insertion depth from the incisors was greater when enteroscopy was performed with an overtube compared with enteroscopy without an overtube (125 cm vs. 110 cm, P=0.05). The median straightened insertion depth beyond the pylorus was significantly greater with overtube use (70 cm vs. 50 cm, P = 0.01). No significant difference between the groups was observed in terms of the likelihood of significant findings at enteroscopy.
Use of an overtube for push enteroscopy results in significantly deeper insertion into the small intestine. Although a larger study would be needed to demonstrate an increase in diagnostic yield and to confirm the safety of overtube use, this study does provide the first objective evidence of an advantage in terms of insertion depth.
尽管在推进式小肠镜检查中通常会使用硬质外套管，人们认为这将有助于增加小肠插入深度，但尚无前瞻性数据支持这一观点。本研究的目的是前瞻性地研究使用与不使用外套管时小肠镜检查插入小肠的深度。
前瞻性研究了38例接受小肠镜检查的患者。交替进行使用或不使用外套管的小肠镜检查；因此，19例患者进行了使用外套管的小肠镜检查，19例未使用外套管。两组在年龄、性别、适应证、荧光镜使用情况及专职麻醉辅助方面匹配良好。通过尽可能推进小肠镜，然后伸直小肠镜直至尖端开始回撤来评估插入深度。伸直后的插入深度与从门牙到幽门的距离之差记录为幽门以外的插入深度。这被视为主要终点。使用非参数数据的Mann-Whitney检验进行统计分析。
与不使用外套管的小肠镜检查相比，使用外套管进行小肠镜检查时，从门牙开始的伸直后的总插入深度中位数更大（125 cm对110 cm，P=0.05）。使用外套管时，幽门以外的伸直后的插入深度中位数显著更大（70 cm对50 cm，P = 0.01）。两组在小肠镜检查时有显著发现的可能性方面未观察到显著差异。
在推进式小肠镜检查中使用外套管可使插入小肠的深度显著增加。尽管需要更大规模的研究来证明诊断率的提高并确认使用外套管的安全性，但本研究确实提供了关于插入深度优势的首个客观证据。
