Saurin J C, Delvaux M, Vahedi K, Gaudin J L, Villarejo J, Florent C, Gay G, Ponchon T
Dept. of Gastroenterology, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Endoscopy. 2005 Apr;37(4):318-23. doi: 10.1055/s-2005-861114.
The long-term outcome for patients with obscure bleeding after capsule endoscopy (CE) is still unclear. In this study, the clinical outcome was used as the gold standard to determine the sensitivity and specificity of CE and push enteroscopy (PE) in the diagnosis of small-bowel lesions in patients with obscure bleeding.
Fifty-eight patients from a previous prospective study (comparing PE and CE) were included; the patients were contacted after 1 year. The final diagnosis, bleeding status, new gastrointestinal examinations, and treatments performed were recorded. On the basis of these data, each case was classified into true/false positive or true/false negative findings at PE and CE. The results were compared with the initial classification of lesions observed at CE: highly relevant (P2) and less relevant (P0, P1) lesions.
Follow-up data were available for 56 patients. According to the defined true/false positive and negative cases, the sensitivity and specificity values for CE and PE were 92 % and 48 %, and 80 % and 69 %, respectively ( P < 0.01 for the difference between CE and PE). Highly relevant (P2) lesions observed at CE were more frequently classified into true-positive cases (15 of 18 versus seven of 22; P < 0.01) and led more frequently to therapeutic decisions (11 of 18 versus five of 22; P = 0.02) in comparison with less relevant lesions (P0, P1).
CE is a highly sensitive examination for the detection of small-bowel lesions in patients with obscure gastrointestinal bleeding, with a specificity lower than that of PE when the clinical outcome is used as the gold standard.
胶囊内镜检查（CE）后不明原因出血患者的长期预后仍不明确。在本研究中，以临床结局作为金标准，来确定CE和推进式小肠镜检查（PE）对不明原因出血患者小肠病变诊断的敏感性和特异性。
纳入了先前一项前瞻性研究（比较PE和CE）中的58例患者；1年后与这些患者取得联系。记录最终诊断、出血状态、新的胃肠道检查及所进行的治疗。基于这些数据，将每例患者在PE和CE检查中的结果分为真/假阳性或真/假阴性。将结果与CE观察到的病变初始分类进行比较：高度相关（P2）和相关性较低（P0、P1）的病变。
56例患者有随访数据。根据定义的真/假阳性和阴性病例，CE和PE的敏感性和特异性值分别为92%和48%，以及80%和69%（CE与PE之间的差异P<0.01）。与相关性较低的病变（P0、P1）相比，CE观察到的高度相关（P2）病变更常被分类为真阳性病例（18例中的15例对22例中的7例；P<0.01），并且更常导致治疗决策（18例中的11例对22例中的5例；P=0.02）。
当以临床结局作为金标准时，CE是检测不明原因胃肠道出血患者小肠病变的高度敏感检查，但其特异性低于PE。
