[胶囊内镜检查的失败与安全性剖析]

Wei Wei, Ge Zhi-Zheng, Gao Yun-Jie, Hu Yun-Biao, Xiao Shu-Dong

Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiaotong University Medical College, Shanghai 200001, China.

Zhonghua Nei Ke Za Zhi. 2008 Jan;47(1):19-22.

OBJECTIVE

To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population.

METHODS

A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done. This included 300 consecutive patients. The median age of the patients was 51 y (range, 3 - 91 y). The young children group was defined as less than 10 years and the elderly group as more than 80 years. Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient. The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed. The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group, elderly group and patients with pacemakers, gastrectomy and Billroth II gastrojejunostomy, intestinal diverticula, Crohn's disease and polyp of small intestine.

RESULTS

A total of 300 patients were involved. The incidence of technical problems was 1.3%, including one case of failing in activating the capsule, one case of failing in loading the data and two cases of short life of battery. Failure of diagnosis was encountered in two cases. The incidence of clinical problems was 33.0% (99 cases) and they caused 35.4% (35 cases) failure of diagnosis in the 99 cases. Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all. In the elderly group, the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%. In two patients with pacemaker no interference between pacemaker and capsule was detected. In two patients with Billroth II gastrojejunostomy no capsule retention occurred. In 16 patients with diverticulum, capsule retention occurred in 1 case (6.0%). In 42 patients with Crohn's disease, capsule retention occurred in 5 cases. No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine.

CONCLUSIONS

With capsule endoscopy technical mistakes causing failure were very rare. The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time. Capsule endoscopy provides a well-tolerated, safe and effective tool to investigate the gastrointestinal diseases, especially some small bowel diseases.

目的

分析导致胶囊内镜检查失败的技术故障和临床问题的发生率及其对诊断的影响，并评估其在特殊患者群体中的可行性和安全性。

方法

对2002年5月至2006年5月期间连续转诊至仁济医院评估疑似小肠疾病的300例患者进行回顾性研究。这包括300例连续患者。患者的中位年龄为51岁（范围3 - 91岁）。幼儿组定义为年龄小于10岁，老年组定义为年龄大于80岁。技术问题是与设备功能相关的问题，临床问题是与患者相关的问题。分析上述事件的发生率、类型及其对诊断的影响。评估胶囊内镜检查在幼儿组、老年组以及有起搏器、胃切除术、毕Ⅱ式胃空肠吻合术、肠道憩室、克罗恩病和小肠息肉患者中的安全性和可行性。

结果

共纳入300例患者。技术问题的发生率为1.3%，包括1例胶囊激活失败、1例数据加载失败和2例电池寿命短。有2例诊断失败。临床问题的发生率为33.0%（99例），在这99例中导致诊断失败的比例为35.4%（35例）。幼儿组中有3例患者无法吞咽胶囊，均成功采用内镜引导下外套管技术。在老年组中，胶囊滞留在食管和胃内的发生率高达23.0%。2例有起搏器的患者未检测到起搏器与胶囊之间的干扰。2例毕Ⅱ式胃空肠吻合术患者未发生胶囊滞留。16例有憩室的患者中，1例发生胶囊滞留（6.0%）。42例克罗恩病患者中，5例发生胶囊滞留。42例克罗恩病患者和5例小肠息肉患者均未发现急性胃肠道梗阻。