Westerhof J, Weersma R K, Koornstra J J
Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands.
Neth J Med. 2009 Jul-Aug;67(7):260-5.
The possibility to visualise the small bowel has dramatically improved with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). CE and DBE have become standard practice in investigating suspected diseases of the small bowel. An important reason to perform small bowel investigations is obscure gastrointestinal bleeding. To investigate obscure gastrointestinal bleeding, some advocate performing CE while others recommend DBE . In this systematic review, we provide an overview of studies in which patients with obscure gastrointestinal bleeding underwent both CE and DBE . These data show that CE and DBE have comparable diagnostic yields in the evaluation of obscure gastrointestinal bleeding of 50 to 60%. Therapeutic interventions using DBE were performed in 11 to 57% of cases. In most studies, there was good concordance between the two procedures but both techniques can be falsely negative. Given its safety, patient tolerability and ability to view the entire small bowel, CE can be recommended as the first investigation for obscure gastrointestinal bleeding, if necessary, followed by DBE . Finally, we provide an algorithm with practical guidelines for the evaluation ofobscure gastrointestinal bleeding.
随着胶囊内镜（CE）和双气囊小肠镜（DBE）的引入，可视化小肠的可能性有了显著提高。CE和DBE已成为怀疑小肠疾病检查的标准方法。进行小肠检查的一个重要原因是不明原因的胃肠道出血。为了调查不明原因的胃肠道出血，一些人主张进行CE，而另一些人则推荐DBE。在这项系统评价中，我们概述了对不明原因胃肠道出血患者同时进行CE和DBE的研究。这些数据表明，在评估不明原因胃肠道出血时，CE和DBE的诊断率相当，为50%至60%。在11%至57%的病例中使用DBE进行了治疗干预。在大多数研究中，两种检查方法之间有良好的一致性，但两种技术都可能出现假阴性结果。鉴于其安全性、患者耐受性以及观察整个小肠的能力，如果有必要，CE可被推荐作为不明原因胃肠道出血的首选检查方法，随后可进行DBE。最后，我们提供了一个用于评估不明原因胃肠道出血的算法及实用指南。
