Hartmann Dirk, Schmidt Harald, Bolz Georg, Schilling Dieter, Kinzel Frank, Eickhoff Axel, Huschner Winfried, Möller Kathleen, Jakobs Ralf, Reitzig Peter, Weickert Uwe, Gellert Klaus, Schultz Harald, Guenther Klaus, Hollerbuhl Hartmut, Schoenleben Klaus, Schulz Hans-Joachim, Riemann Juergen F
Department of Gastroenterology, Academic Teaching Hospital, Ludwigshafen, Germany.
Gastrointest Endosc. 2005 Jun;61(7):826-32. doi: 10.1016/s0016-5107(05)00372-x.
Capsule endoscopy enables noninvasive diagnostic examination of the entire small intestine. However, sensitivity and specificity of capsule endoscopy have not been adequately defined. We, therefore, compared capsule endoscopy by using intraoperative enteroscopy as a criterion standard in patients with obscure GI bleeding.
Forty-seven consecutive patients with obscure GI bleeding (11 with ongoing overt bleeding, 24 with previous overt bleeding, and 12 with obscure-occult bleeding) from two German gastroenterologic centers were included. All patients who had a prior nondiagnostic evaluation, including upper endoscopy, colonoscopy with a retrograde examination of the distal ileum, and push enteroscopy, underwent capsule endoscopy followed by intraoperative enteroscopy.
Capsule endoscopy identified lesions in 100% of the patients with ongoing overt bleeding, 67% of the patients with previous overt bleeding, and 67% of the patients with obscure-occult bleeding. Angiectasias were the most common source of bleeding (n = 22). Capsule endoscopy showed the source of bleeding in 74.4% of all patients. The method was more effective in patients with ongoing bleeding. Compared with intraoperative enteroscopy sensitivity, specificity, and positive and negative predictive values of capsule endoscopy were 95%, 75%, 95%, and 86%, respectively.
Capsule endoscopy has high sensitivity and specificity to detect a bleeding source in patients with obscure GI bleeding. Thus, wireless capsule endoscopy can be recommended as part of the routine work-up in patients with obscure GI bleeding.
胶囊内镜可对整个小肠进行无创诊断检查。然而，胶囊内镜的敏感性和特异性尚未得到充分界定。因此，我们以术中肠镜检查作为标准，比较了胶囊内镜在不明原因消化道出血患者中的应用。
纳入来自两个德国胃肠病中心的47例连续的不明原因消化道出血患者（11例为持续性显性出血，24例为既往显性出血，12例为不明原因隐匿性出血）。所有先前评估未明确诊断的患者，包括上消化道内镜检查、结肠镜检查及回肠末端逆行检查和推进式肠镜检查，均先接受胶囊内镜检查，随后进行术中肠镜检查。
胶囊内镜在100%的持续性显性出血患者、67%的既往显性出血患者和67%的不明原因隐匿性出血患者中发现了病变。血管扩张是最常见的出血来源（n = 22）。胶囊内镜在74.4%的患者中显示了出血来源。该方法在正在出血的患者中更有效。与术中肠镜检查相比，胶囊内镜的敏感性、特异性、阳性和阴性预测值分别为95%、75%、95%和86%。
胶囊内镜在检测不明原因消化道出血患者的出血来源方面具有高敏感性和特异性。因此，无线胶囊内镜可推荐作为不明原因消化道出血患者常规检查的一部分。
