Cheifetz Adam S, Lewis Blair S
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Clin Gastroenterol. 2006 Sep;40(8):688-91. doi: 10.1097/00004836-200609000-00005.
Capsule endoscopy has been found superior to barium x-rays and push enteroscopy in the investigation of obscure gastrointestinal bleeding and in the evaluation of suspected Crohn's disease. Currently, small bowel obstruction and strictures are considered by many physicians to be a contraindication to capsule endoscopy for fear of capsule retention or impaction. The goal of this study was to reassess this conventional wisdom that capsule endoscopy is contraindicated in small bowel obstruction and to determine the safety and efficacy of capsule endoscopy in the evaluation of patients with suspected stricture or small bowel obstruction.
A retrospective chart review was performed using a database of 568 capsule endoscopy cases performed between August 2001 and November 2003. Cases of suspected small bowel obstruction were selected and reviewed.
Nineteen cases were identified in which capsule endoscopy was used in the setting of suspected small bowel obstruction. The diagnosis of suspected small bowel obstruction was based on symptoms alone in 8 cases and on symptoms plus abnormal radiographs in the remaining 11 cases. Capsule endoscopy made a definitive diagnosis in 5 of the 19 cases (26%): 2 Crohn's strictures, 1 radiation induced stricture, 1 nonsteroidal anti-inflammatory drug induced stricture, and 1 MALT lymphoma. The capsule was retained proximal to a stricture in 4 cases, in which the obstructing lesions were electively resected without complications. There was no case in which administration of the capsule led to an acute small bowel obstruction.
Capsule endoscopy can be safely used to help identify the etiology and site of a small bowel obstruction. Retention of the capsule may indicate the presence of a lesion requiring surgery, but small bowel obstruction or strictures are not in themselves contraindications to the procedure. It is understood, however, that retention may lead to surgery in a patient who otherwise may have been treated medically without surgery for the same illness (eg, Crohn's disease and nonsteroidal anti-inflammatory drug enteropathy).
在不明原因的胃肠道出血的检查以及疑似克罗恩病的评估中，胶囊内镜已被证明优于钡剂X线检查和推进式小肠镜检查。目前，许多医生认为小肠梗阻和狭窄是胶囊内镜检查的禁忌症，因为担心胶囊滞留或嵌顿。本研究的目的是重新评估这种认为小肠梗阻患者禁忌进行胶囊内镜检查的传统观念，并确定胶囊内镜在疑似狭窄或小肠梗阻患者评估中的安全性和有效性。
使用2001年8月至2003年11月期间进行的568例胶囊内镜检查病例的数据库进行回顾性图表审查。选择并审查疑似小肠梗阻的病例。
共确定19例在疑似小肠梗阻情况下使用胶囊内镜检查的病例。8例仅根据症状诊断为疑似小肠梗阻，其余11例根据症状加X线片异常诊断。胶囊内镜在19例中的5例（26%）中做出了明确诊断：2例克罗恩狭窄、1例放射性狭窄、1例非甾体抗炎药引起的狭窄和1例黏膜相关淋巴组织淋巴瘤。4例胶囊滞留在狭窄近端，其中梗阻性病变经选择性切除无并发症。没有一例因服用胶囊导致急性小肠梗阻。
胶囊内镜可安全用于帮助识别小肠梗阻的病因和部位。胶囊滞留可能表明存在需要手术的病变，但小肠梗阻或狭窄本身并非该检查的禁忌症。然而，可以理解的是，胶囊滞留可能导致原本可以通过药物治疗而非手术治疗同一疾病（如克罗恩病和非甾体抗炎药肠病）的患者接受手术。
