Lin Sauyu, Rockey Don C
Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA.
Gastroenterol Clin North Am. 2005 Dec;34(4):679-98. doi: 10.1016/j.gtc.2005.08.005.
Obscure GI bleeding is a relatively common problem facing internists, gastroenterologists, and surgeons in a typical clinical practice. The etiology is occasionally suggested by the patient's age, history, and medications. Management is complicated and typically requires a team-oriented approach, with input from the internist, gastroenterologist, radiologist, and surgeon alike. SBFT and enteroclysis seem to have a limited role, unless there is a high suspicion of a small bowel mass lesion or Crohn's disease. Scintigraphy may be performed in patients with active bleeding in whom endoscopy has failed oris contraindicated. Angiography may be used in patients with an early positive nuclear imaging or failed endoscopic therapy. Provocative angiography probably has a lower diagnostic yield than previously reported, and should be performed only in experienced centers. Helical CT is a new and potentially important option in patients with obscure bleeding, but is currently considered experimental. All patients with obscure GI bleeding should undergo repeat upper endoscopy and perhaps colonoscopy to rule out missed lesions. SBE seems to be complementary to capsule endoscopy, and it is unknown whether this should be performed before capsule endoscopy or only if capsule endoscopy yields a positive proximal small bowel finding. Double balloon enteroscopy seems promising, but the technique requires further study. Surgery should be reserved for patients who have a positive capsule endoscopy requiring surgical therapy or patients who have persistent GI bleeding requiring recurrent blood transfusions in whom all other modalities have failed. Treatment for vascularectasias, the most common cause of obscure GI bleeding, is currently inadequate,and typically requires a combination of multiple management approaches.
隐匿性胃肠道出血是内科医生、胃肠病学家和外科医生在日常临床实践中面临的一个相对常见的问题。患者的年龄、病史和用药情况偶尔能提示病因。其处理较为复杂，通常需要团队协作，内科医生、胃肠病学家、放射科医生和外科医生都要参与其中。小肠钡剂灌肠造影（SBFT）和小肠灌肠造影的作用似乎有限，除非高度怀疑有小肠肿块病变或克罗恩病。对于内镜检查失败或有禁忌证的活动性出血患者，可进行闪烁扫描。对于核素显像早期阳性或内镜治疗失败的患者，可采用血管造影。激发性血管造影的诊断率可能比之前报道的要低，应仅在有经验的中心进行。螺旋CT是隐匿性出血患者的一种新的、可能很重要的选择，但目前仍被视为试验性方法。所有隐匿性胃肠道出血患者都应接受重复上消化道内镜检查，可能还需进行结肠镜检查，以排除漏诊病变。小肠钡剂灌肠造影似乎是胶囊内镜的补充，目前尚不清楚应在胶囊内镜检查之前进行，还是仅在胶囊内镜检查发现近端小肠有阳性结果时才进行。双气囊小肠镜检查似乎很有前景，但该技术还需要进一步研究。手术应仅用于胶囊内镜检查阳性且需要手术治疗的患者，或其他所有治疗方法均失败但仍有持续性胃肠道出血且需要反复输血的患者。血管扩张是隐匿性胃肠道出血最常见的原因，目前其治疗方法并不完善，通常需要多种处理方法联合使用。
