胃肠道内镜检查对肠衰竭患儿的诊断率高。
High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure.
作者信息
Ching Y Avery, Modi Biren P, Jaksic Tom, Duggan Christopher
机构信息
Center for Advanced Intestinal Rehabilitation, Children's Hospital Boston and Harvard Medical School, Boston, MA 02215, USA.
出版信息
J Pediatr Surg. 2008 May;43(5):906-10. doi: 10.1016/j.jpedsurg.2007.12.037.
PURPOSE
Children with intestinal failure (IF) often have gastrointestinal (GI) symptoms, including bleeding, increased stool output, and feeding intolerance. The use of endoscopic assessment of these symptoms has not been previously reported. This report evaluates the diagnostic yield of GI endoscopy in the setting of IF.
METHODS
After institutional review board approval, we reviewed the medical records (including endoscopy, pathology and microbiology data) of patients with IF who underwent GI endoscopies between September 1999 and March 2007.
RESULTS
Twenty-seven patients underwent 61 GI endoscopies: 34 esophagogastroduodenoscopies, 17 colonoscopies, 7 flexible sigmoidoscopies, and 3 ileoscopies. Indications for endoscopy, which were not mutually exclusive, included chronic diarrhea (39%, n = 24), GI bleeding (36%, n = 22), suspected bacterial overgrowth (36%, n = 22), and suspected peptic disease (15%, n = 9). Based on gross endoscopic appearance, histopathology, or microbiology, 43 (70%) procedures yielded abnormalities. These included infectious (20%, n = 12), anatomical (18%, n = 11), peptic (15%, n = 9), allergic (15%, n = 9), and other (2%, n = 1) findings. Eleven (73%) of 15 duodenal cultures grew a spectrum of 17 bacterial species. Overall, 24 (89%) of 27 patients had gross endoscopic, histopathologic, or microbiologic abnormalities.
CONCLUSIONS
In pediatric patients with IF, diagnostic upper and lower GI endoscopies yield high rates of abnormalities and can help guide clinical management.
目的
肠道衰竭（IF）患儿常出现胃肠道（GI）症状，包括出血、粪便量增加和喂养不耐受。此前尚未有关于对这些症状进行内镜评估的报道。本报告评估了在IF情况下胃肠道内镜检查的诊断价值。
方法
经机构审查委员会批准后，我们回顾了1999年9月至2007年3月期间接受胃肠道内镜检查的IF患儿的病历（包括内镜检查、病理学和微生物学数据）。
结果
27例患者接受了61次胃肠道内镜检查：34次食管胃十二指肠镜检查、17次结肠镜检查、7次乙状结肠镜检查和3次回肠镜检查。内镜检查的适应证并非相互排斥，包括慢性腹泻（39%，n = 24）、胃肠道出血（36%，n = 22）、疑似细菌过度生长（36%，n = 22）和疑似消化性疾病（15%，n = 9）。基于内镜大体表现、组织病理学或微生物学检查，43次（70%）检查发现异常。这些异常包括感染性（20%，n = 12）、解剖学（18%，n = 11）、消化性（15%，n = 9）、过敏性（15%，n = 9）和其他（2%，n = 1）发现。15次十二指肠培养中有11次（73%）培养出17种细菌。总体而言，27例患者中有24例（89%）存在内镜大体、组织病理学或微生物学异常。
结论
在患有IF的儿科患者中，诊断性上消化道和下消化道内镜检查发现异常的比例很高，有助于指导临床管理。
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