Department of Gastroenterology, Nagoya University Graduate School of Medicine, and Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Gastroenterol. 2010 Jun;45(6):592-9. doi: 10.1007/s00535-010-0202-z. Epub 2010 Feb 3.
Double-balloon endoscopy (DBE) utilizes both oral and anal routes. The proper selection of the initial route is important for more rapid management of obscure gastrointestinal bleeding (OGIB). The aim of this retrospective study was to clarify the accuracy of the transit time of video capsule endoscopy (VCE) to the lesion as a predictive indicator for the decision on the initial DBE route.
Of 172 patients who underwent both DBE and VCE, 65 who were diagnosed with small-intestinal hemorrhagic lesions by both means were enrolled. The relation between VCE transit time to the lesion and the DBE route by which the lesion was discovered was analyzed, distinguishing between 46 complete and 19 incomplete VCEs.
Among the 46 patients with a complete VCE, the transit time and position of the lesion were strongly correlated. The best cutoff values for route selection by the VCE transit time from capsule intake and from the duodenal bulb to the lesion, determined using a receiver operating characteristic (ROC) curve, were 60% and 50%, respectively, of the transit time to the cecum. At that point, the accuracy of route selection was 90% and 94%, respectively. Positions shown by VCE for ileal lesions tended to be more proximal than those shown by surgery. In the 19 patients with incomplete VCEs, the best cutoff for transit time was 180 min from the duodenal bulb.
The VCE transit time was useful for determining the route for DBE in OGIB. This parameter was most accurate when the cutoff value for the selection was half of the small-bowel transit time in the complete VCE examination.
双气囊内镜（DBE）同时使用口腔和肛门入路。选择合适的初始入路对于快速处理不明原因胃肠道出血（OGIB）非常重要。本回顾性研究的目的是阐明胶囊内镜（VCE）通过病变的传输时间作为决定初始 DBE 入路的预测指标的准确性。
在 172 例行 DBE 和 VCE 的患者中，纳入了 65 例通过两种方法诊断为小肠出血性病变的患者。分析了 VCE 通过病变的传输时间与发现病变的 DBE 入路之间的关系，区分了 46 例完全 VCE 和 19 例不完全 VCE。
在 46 例完全 VCE 患者中，VCE 传输时间和病变位置具有很强的相关性。使用受试者工作特征（ROC）曲线确定的 VCE 传输时间从胶囊摄入到十二指肠球部到病变的最佳选择切点值分别为 60%和 50%，这两个切点值分别为到盲肠的传输时间的 50%。此时，选择路径的准确率分别为 90%和 94%。VCE 显示的回肠病变位置倾向于比手术显示的更靠近近端。在 19 例不完全 VCE 患者中，传输时间的最佳切点值为从十二指肠球部开始的 180 分钟。
VCE 传输时间可用于确定 OGIB 中 DBE 的入路。当选择的切点值为完全 VCE 检查中小肠传输时间的一半时，该参数最准确。
