Lin Tsung-Nan, Su Ming-Yao, Hsu Chen-Ming, Lin Wei-Pin, Chiu Cheng-Tang, Chen Pang-Chi
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2008 Sep-Oct;31(5):450-6.
Most of the sources of bleeding in patients with obscure gastrointestinal bleeding are located in the small bowel. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are innovative modalities to examine the small intestine. This study evaluated the combined use of CE and DBE in patients with obscure gastrointestinal bleeding.
From October 2005 to November 2006, ten patients with obscure gastrointestinal bleeding who underwent CE followed by DBE were included in this study. The insertion route for DBE was determined according to the site of obscure gastrointestinal bleeding detected by CE in nine patients. The anterograde route was selected when the estimated location of the lesion was in the proximal two-thirds of the small bowel and the retrograde route was chosen when the estimated location was after the proximal two-thirds. In one patient without a definite lesion detected by CE, the route of insertion was determined according to clinical judgment.
Eleven capsule endoscopies were performed in ten patients. Significant or suspicious small bowel lesions were discovered by CE in nine (90%; 9/10) patients, including angiodysplasia (n=3), active bleeding (n=3), a polypoid lesion (n=1), suspected enteritis (n=1) and gastric antral vascular ectasia with small bowel bleeding (n=1). Eleven DBE were performed in ten patients. Significant small bowel lesions were detected by DBE in eight patients (80%), including angiodysplasias (n=3), lymphangioectasias (n= 2), varices (n=1), polypoid lesion (n=1) and Dieulafoy's lesion (n=1). Endoscopic treatments were performed successfully in 7 patients, including argon plasma coagulation in four, heat probe coagulation in one, endoscopic mucosal resection in one and sclerotherapy in one.
CE can provide useful information on the indications for DBE and the selection of the route of DBE. DBE can verify the findings of CE and provide therapeutic intervention. Combined use of CE and DBE is effective in the diagnosis and management of patients with obscure gastrointestinal bleeding.
不明原因胃肠道出血患者的出血来源大多位于小肠。胶囊内镜（CE）和双气囊小肠镜（DBE）是检查小肠的创新方法。本研究评估了CE和DBE联合应用于不明原因胃肠道出血患者的情况。
2005年10月至2006年11月，本研究纳入了10例接受CE检查后再行DBE检查的不明原因胃肠道出血患者。9例患者根据CE检测到的不明原因胃肠道出血部位确定DBE的插入途径。当病变估计位置在小肠近端三分之二时选择顺行途径，当估计位置在近端三分之二之后时选择逆行途径。1例CE未检测到明确病变的患者，根据临床判断确定插入途径。
10例患者共进行了11次胶囊内镜检查。CE在9例（90%；9/10）患者中发现了显著或可疑的小肠病变，包括血管发育异常（n = 3）、活动性出血（n = 3）、息肉样病变（n = 1）、疑似肠炎（n = 1）和伴有小肠出血的胃窦血管扩张（n = 1）。10例患者共进行了11次DBE检查。DBE在8例患者（80%）中检测到显著的小肠病变，包括血管发育异常（n = 3）、淋巴管扩张（n = 2）、静脉曲张（n = 1）、息肉样病变（n = 1）和Dieulafoy病变（n = 1）。7例患者成功进行了内镜治疗，包括4例氩离子凝固术、1例热探头凝固术、1例内镜黏膜切除术和1例硬化疗法。
CE可为DBE的适应证及DBE插入途径的选择提供有用信息。DBE可验证CE的检查结果并提供治疗干预。CE和DBE联合应用对不明原因胃肠道出血患者的诊断和治疗有效。
