Rondonotti Emanuele, Villa Federica, Mulder Chris J J, Jacobs Maarten A J M, de Franchis Roberto
Universuta degli Studi di Milano, IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena, Unita Operativa di Gastroenterologia 3, Via Pace 9, Milano 20122, Italy.
World J Gastroenterol. 2007 Dec 14;13(46):6140-9. doi: 10.3748/wjg.v13.i46.6140.
Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions). The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).
胶囊内镜通过提供一种可靠的方法，以内镜方式评估整个小肠，彻底改变了小肠研究。在过去六年里，已有多篇论文发表，探讨了这项检查在不同临床情况下可能发挥的作用。目前，对于不明原因胃肠道出血的患者，在双向内镜检查结果为阴性后，胶囊内镜通常被推荐作为第三种检查手段。越来越多的证据表明，这项检查在其他临床情况中也发挥着重要作用，如克罗恩病、乳糜泻、小肠息肉综合征或小肠肿瘤。这项检查的主要并发症是装置滞留在先前未知的小肠狭窄部位。然而，由于该工具的技术限制（无法远程控制、不能取活检、不能注气、不能抽吸液体或碎片，有时无法正确测量病变大小和定位病变），还存在一些其他未解决的问题。最近开发的双气囊小肠镜，尽管具有侵入性且耗时，但由于其能够探查大部分小肠并进行靶向活检，能够克服胶囊内镜的一些局限性。目前，在大多数临床情况（如不明原因胃肠道出血）中，成功的策略似乎是将这两种技术结合起来，以无痛、安全且完整的方式（通过胶囊内镜）探查小肠，并确定和治疗所发现的病变（通过双气囊小肠镜）。
