Böcker Ulrich, Dinter Dietmar, Litterer Caroline, Hummel Frank, Knebel Phillip, Franke Andreas, Weiss Christel, Singer Manfred V, Löhr J-Matthias
University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Scand J Gastroenterol. 2010 Apr;45(4):490-500. doi: 10.3109/00365520903567817.
New technology has considerably advanced the diagnosis of small-bowel pathology. However, its significance in clinical algorithms has not yet been fully assessed. The aim of the present analysis was to compare the diagnostic utility and yield of video-capsule enteroscopy (VCE) to that of magnetic resonance imaging (MRI) in patients with suspected or established Crohn's disease (Group I), obscure gastrointestinal blood loss (Group II), or suspected tumors (Group III).
Forty-six out of 182 patients who underwent both modalities were included: 21 in Group I, 20 in Group II, and five in Group III. Pathology was assessed in three predetermined sections of the small bowel (upper, middle, and lower). The McNemar and Wilcoxon tests were used for statistical analysis.
In Group I, lesions were found by VCE in nine of the 21 patients and by MRI in six. In five patients, both modalities showed pathology. In Group II, pathological changes were detected in 11 of the 20 patients by VCE and in eight patients by MRI. In five cases, pathology was found with both modalities. In Group III, neither modality showed small-bowel pathology. For the patient groups combined, diagnostic yield was 43% with VCE and 30% with MRI. The diagnostic yield of VCE was superior to that of MRI in the upper small bowel in both Groups I and II.
VCE is superior to MRI for the detection of lesions related to Crohn's disease or obscure gastrointestinal bleeding in the upper small bowel.
新技术极大地推动了小肠疾病的诊断。然而，其在临床诊疗流程中的意义尚未得到充分评估。本分析的目的是比较在疑似或确诊克罗恩病患者（第一组）、不明原因的胃肠道出血患者（第二组）或疑似肿瘤患者（第三组）中，视频胶囊内镜检查（VCE）与磁共振成像（MRI）的诊断效用和检出率。
182例接受了两种检查方式的患者中，46例被纳入研究：第一组21例，第二组20例，第三组5例。对小肠的三个预定节段（上段、中段和下段）进行病理评估。采用McNemar检验和Wilcoxon检验进行统计分析。
在第一组中，21例患者中有9例通过VCE发现病变，6例通过MRI发现病变。5例患者两种检查方式均显示有病理改变。在第二组中，20例患者中有11例通过VCE检测到病理变化，8例通过MRI检测到。5例患者两种检查方式均发现有病理改变。在第三组中，两种检查方式均未显示小肠有病理改变。对于合并的患者组，VCE的诊断检出率为43%，MRI为30%。在第一组和第二组中，VCE在上段小肠的诊断检出率均优于MRI。
在检测上段小肠中与克罗恩病或不明原因胃肠道出血相关的病变方面，VCE优于MRI。
