经推式内镜检查后持续不明原因胃肠道出血的逆行双球囊内镜检查：是否有作用？

Antegrade double balloon enteroscopy for continued obscure gastrointestinal bleeding following push enteroscopy: is there a role?

机构信息

AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Suite 604, 35 Spring St Bondi Junction, Sydney, NSW 2022, Australia.

出版信息

Dig Dis Sci. 2010 May;55(5):1381-4. doi: 10.1007/s10620-009-0892-3. Epub 2009 Jul 16.

DOI:10.1007/s10620-009-0892-3

PMID:19609674

Abstract

BACKGROUND

The benefit of double balloon endoscopy (DBE) over push enteroscopy (PE) for the proximal small bowel in patients with obscure gastrointestinal bleeding remains unclear.

AIM

To quantify the benefit of DBE if PE fails to benefit patients with obscure gastrointestinal bleeding.

METHODS

This retrospective DBE database review between July 2004 and April 2008 was conducted at a tertiary university hospital in Australia. Thirty-three patients with obscure gastrointestinal bleeding who had undergone PE for proximal small bowel lesions were identified from a DBE database of 280 patients. Mean age was 68.6 (range 30-91) years, and 17 were men. In group A (n = 15) the target lesion was not reached by PE, and in group B (n = 18) an abnormality was found by PE (angioectasia in 17 and red spots in 1) but the patient had ongoing bleeding. Mean follow-up for the cohort was 19.2 (range 5-39) months. DBE interventions were performed as appropriate.

RESULTS

An abnormality was found at DBE in 28/33 (85%) patients. DBE found an abnormality in 12/15 (80%) in group A and 16/18 (89%) in group B. Endoscopic intervention was performed in 23/33 patients (70%). In 27/33 (82%) patients a clinical benefit was seen following DBE. Six patients (18%) had no clinical benefit from DBE.

CONCLUSIONS

In patients with obscure gastrointestinal bleeding and proximal small bowel lesions who fail to benefit from PE, DBE offers a very high benefit in finding and treating lesions with good long-term outcomes.

摘要

背景

双气囊内镜（DBE）在不明原因胃肠道出血患者中的近端小肠检查优于推进式内镜（PE），但这一优势仍不明确。

目的

明确如果 PE 对不明原因胃肠道出血患者无益，DBE 能带来多大的益处。

方法

该研究为回顾性 DBE 数据库研究，于 2004 年 7 月至 2008 年 4 月在澳大利亚一所三级大学医院进行。从 280 例 DBE 数据库中，共发现 33 例接受 PE 检查近端小肠病变的不明原因胃肠道出血患者。患者平均年龄 68.6 岁（范围 30-91 岁），17 例为男性。A 组（n = 15）PE 未能到达目标病变，B 组（n = 18）PE 发现异常（血管扩张 17 例，红点 1 例）但患者持续出血。该队列的平均随访时间为 19.2 个月（范围 5-39 个月）。根据需要进行 DBE 干预。

结果

33 例患者中有 28 例（85%）在 DBE 中发现异常。A 组 15 例中，DBE 发现异常 12 例（80%），B 组 18 例中发现异常 16 例（89%）。33 例患者中有 23 例（70%）进行了内镜干预。27 例（82%）患者在 DBE 后获得临床获益。6 例（18%）患者 DBE 无临床获益。