Tabibian N
Section of Digestive Diseases, Visalia Medical Clinic, CA 93291.
South Med J. 1991 Feb;84(2):219-21. doi: 10.1097/00007611-199102000-00016.
I did esophagogastroduodenoscopy in 147 patients and colonoscopy in 59 patients who had had gastrointestinal x-ray studies. The endoscopic procedure was done within 7 days after the x-ray study and/or while the patient was still symptomatic. The barium swallow findings were confirmed in only 40%; in the other 60%, the x-ray findings could not be confirmed. These unconfirmed x-ray findings were false-positive in 37.4%, false-negative in 16.3%, and suboptimal or nondiagnostic in 6.2%. The barium enema findings were confirmed in 32%. In the other 68%, the x-ray findings were false-positive in 42.3%, false-negative in 22%, and suboptimal in 3.3%. We conclude that in clinical or private practice, relying on x-ray studies alone may be associated with a high margin of diagnostic errors. When all factors are considered, the initial cost advantage of the x-ray studies appears to be lost. In future recommendations on the continuing dilemma of x-ray studies versus endoscopy, consideration should be given to factors other than the initial lower price of the x-ray studies.
我对147例患者进行了食管胃十二指肠镜检查，对59例已进行过胃肠道X线检查的患者进行了结肠镜检查。内镜检查在X线检查后7天内进行和/或在患者仍有症状时进行。仅40%的钡餐检查结果得到证实；在另外60%的病例中，X线检查结果未得到证实。这些未得到证实的X线检查结果中，假阳性占37.4%，假阴性占16.3%，欠佳或无法诊断的占6.2%。钡剂灌肠检查结果得到证实的占32%。在另外68%的病例中，X线检查结果假阳性占42.3%，假阴性占22%，欠佳的占3.3%。我们得出结论，在临床或私人执业中，仅依靠X线检查可能会有较高的诊断误差率。综合考虑所有因素，X线检查最初的成本优势似乎不复存在。在未来关于X线检查与内镜检查持续困境的建议中，应考虑除X线检查最初较低价格之外的其他因素。
