Tanaka Shu, Mitsui Keigo, Yamada Yukie, Ehara Akihito, Kobayashi Tsuyoshi, Seo Tsuguhiko, Tatsuguchi Atsushi, Fujimori Shunji, Gudis Katya, Sakamoto Choitsu
Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Gastrointest Endosc. 2008 Oct;68(4):683-91. doi: 10.1016/j.gie.2008.03.1062. Epub 2008 Jun 17.
Double-balloon endoscopy (DBE) is a new method that allows visualization, tissue sampling, and therapeutic intervention of a variety of pathologies throughout the small-intestinal tract.
In the present study, we evaluated the diagnostic yield of DBE and its impact on the final diagnosis, treatment, and clinical outcome of patients with obscure GI bleeding (OGIB).
A hospital-based cross-sectional, follow-up study.
We studied 108 consecutive patients (66 men and 42 women) referred to our hospital from July 2003 to February 2007 for the evaluation of OGIB: 13 patients with overt-ongoing bleeding, 76 with overt-previous bleeding, and 19 with occult OGIB.
Diagnostic yield, a final diagnosis, treatment, and clinical outcome were all analyzed in each group.
DBE diagnostic rates for patients with overt-ongoing, overt-previous, and occult bleeding were 100.0%, 48.4% and 42.1%, respectively. The difference in diagnostic yields between the overt-ongoing group and the 2 other groups was statistically significant (P < .005). The most common sources of bleeding were ulcers and tumor lesions. Small-intestinal lesions were identified in 52 of 108 patients; of which 36 patients (69.2%) were biopsied and 49 patients (94.2%) received treatment. Eight patients (7.4%) had recurrent bleeding during the mean follow-up period of 28.5 months. Sensitivity, specificity, and positive and negative predictive values of DBE in the diagnoses of small-intestinal lesions in patients with OGIB were 92.7%, 96.4%, 98.1%, and 87.1%, respectively. No serious complications were encountered.
DBE was proven to be a very useful diagnostic tool and had a therapeutic impact in the majority of patients with OGIB. The best candidates for the procedure were patients with overt-ongoing bleeding.
双气囊小肠镜检查（DBE）是一种新方法，可用于观察整个小肠的各种病变、进行组织采样及治疗干预。
在本研究中，我们评估了DBE的诊断率及其对不明原因消化道出血（OGIB）患者最终诊断、治疗及临床结局的影响。
一项基于医院的横断面随访研究。
我们研究了2003年7月至2007年2月期间连续转诊至我院评估OGIB的108例患者（66例男性和42例女性）：13例活动性显性出血患者，76例既往显性出血患者，19例隐匿性OGIB患者。
对每组患者的诊断率、最终诊断、治疗及临床结局进行分析。
活动性显性出血、既往显性出血和隐匿性出血患者的DBE诊断率分别为100.0%、48.4%和42.1%。活动性显性出血组与其他两组的诊断率差异具有统计学意义（P < 0.005）。最常见的出血来源是溃疡和肿瘤病变。108例患者中有52例发现小肠病变；其中36例患者（69.2%）接受了活检，49例患者（94.2%）接受了治疗。在平均28.5个月的随访期内，8例患者（7.4%）出现复发性出血。DBE对OGIB患者小肠病变诊断的敏感性、特异性、阳性预测值和阴性预测值分别为92.7%、96.4%、98.1%和87.1%。未发生严重并发症。
DBE被证明是一种非常有用的诊断工具，对大多数OGIB患者有治疗作用。该检查的最佳适应证是活动性显性出血患者。
