Kovács Márta, Németh Artur, Pák Péter, Uhlyarik Andrea, Pák Gábor, Rácz István
Vaszary Kolos Kórház, II. Belgyógyászati Osztály, Esztergom.
Orv Hetil. 2006 Sep 24;147(38):1827-33.
The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding.
During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months.
A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding.
Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.
小肠胶囊内镜的主要适应证是不明原因的胃肠道出血的诊断。本回顾性研究旨在分析胶囊内镜对不明原因胃肠道出血患者的诊断率、阳性和阴性预测值以及临床影响。
在两个工作场所的36个月期间，对62例接受了非诊断性上消化道内镜检查和结肠镜检查的胃肠道出血患者进行了66次胶囊内镜检查。两个工作场所的两名研究人员对胶囊视频记录进行了评估。根据出血来源，胶囊内镜检查结果分为3组：明确的出血来源（48例患者）、不确定的出血可能性（5例患者）和阴性结果（8例患者）。胶囊内镜检查后的患者随访平均20（1 - 41）个月。
在接受胶囊内镜检查的病例中，78.7%检测到明确的小肠出血来源。明确的出血来源分别包括血管发育异常（28例）、小肠克罗恩病（5例）、小肠肿瘤（5例）、小肠狭窄（2例）、非甾体抗炎药治疗相关溃疡（1例）、非特异性炎症（1例）和蠕虫感染（1例）。胶囊内镜检查的阳性和阴性预测值分别为95.8%和84.6%。在有明确出血来源的病例中，72%的患者根据胶囊内镜检查结果接受了治疗（18例患者接受手术，16例患者调整药物治疗，1例患者接受化疗栓塞）。在随访期间，17.7%的患者再次出血。
胶囊内镜是诊断不明原因胃肠道出血的一种有用且有效的诊断方法。可根据大多数阳性胶囊内镜检查结果进行有效治疗。
