De Leusse A, Landi B, Edery J, Burtin P, Lecomte T, Seksik P, Bloch F, Jian R, Cellier C
Service d'Hépatogastroentérologie, Hôpital Européen Georges Pompidou, Paris, France.
Endoscopy. 2005 Jul;37(7):617-21. doi: 10.1055/s-2005-861419.
The aim of the study was to assess the feasibility, diagnostic yield, and interobserver agreement of capsule endoscopy in the investigation of patients with obscure or occult gastrointestinal bleeding.
A total of 64 consecutive patients with occult bleeding (31 %) or overt bleeding (69 %) were assessed using capsule endoscopy after negative upper and lower endoscopy and small-bowel radiology. The quality of visualization of the small-bowel mucosa was scored from 1 (poor) to 4 (excellent). Thirty video capsule recordings with normal or abnormal findings were blindly assessed by four independent endoscopists. Interobserver agreement was evaluated using the kappa index.
The small bowel was completely visualized in 57/64 patients (89 %). Incomplete small-bowel transit was most commonly due to prolonged gastric retention (five patients). The mucosa visualization scores (means) for the proximal, middle, and distal thirds of the small bowel were 3.7, 3.3, and 2.2 respectively. Visualization of the distal ileum was good (> or = 3) in 38 % and a bleeding site was found in 45 % of patients. Push-enteroscopy was also performed in 56 patients. The results of the two techniques were similar in 37 patients, capsule endoscopy was superior in 12 patients, and push-enteroscopy was superior in seven patients. Interobserver agreement was good for bleeding and for angiodysplasia, but poor for ulcers and tumors. Mean interobserver agreement was better among experienced endoscopists than among junior endoscopists.
Capsule endoscopy allowed the whole small intestine to be explored in 89 % of patients, with good visualization of the mucosa, except distally. Interobserver agreement was better among the experienced endoscopists and was better for red-colored abnormalities (bleeding and angiodysplasia) than for ulcers and tumors.
本研究旨在评估胶囊内镜在不明原因或隐匿性胃肠道出血患者检查中的可行性、诊断率及观察者间的一致性。
连续纳入64例隐匿性出血（31%）或显性出血（69%）患者，在上下消化道内镜及小肠造影检查均为阴性后，接受胶囊内镜检查。小肠黏膜的可视化质量从1分（差）到4分（优）进行评分。由4名独立内镜医师对30份有正常或异常表现的视频胶囊记录进行盲法评估。使用kappa指数评估观察者间的一致性。
64例患者中有57例（89%）小肠得到完全观察。小肠通过时间不完全最常见的原因是胃潴留时间延长（5例）。小肠近端、中部和远端三分之一的黏膜可视化评分（平均值）分别为3.7、3.3和2.2。38%的患者回肠末端可视化良好（≥3分），45%的患者发现出血部位。56例患者还接受了推进式小肠镜检查。两种技术结果在37例患者中相似，胶囊内镜在12例患者中更优，推进式小肠镜在7例患者中更优。观察者间对出血和血管发育异常的一致性良好，但对溃疡和肿瘤的一致性较差。经验丰富的内镜医师之间的平均观察者间一致性优于初级内镜医师。
胶囊内镜使89%的患者能够对整个小肠进行探查，黏膜可视化良好，但远端除外。经验丰富的内镜医师之间观察者间一致性更好，对于红色异常（出血和血管发育异常）的一致性优于溃疡和肿瘤。
