Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2011 May;26(5):901-7. doi: 10.1111/j.1440-1746.2010.06577.x.
Computed tomography enterography (CTE) is a promising modality for small bowel imaging. However, the role of CTE in the evaluation of obscure gastrointestinal bleeding (OGIB) has not been established. We investigated the efficacy of CTE in diagnosing OGIB and the long-term outcomes based on CTE findings, with special reference to negative CTE.
A total of 63 consecutive patients who had undergone CTE for OGIB were enrolled, and their pre- and post-CTE clinical data were collected. "Specific treatments" were defined as treatments directly aimed at resolving presumed bleeding causes, including hemostasis and operation, while "non-specific treatments" were defined as symptomatic treatments for anemia.
Among 60 patients for whom long-term follow-up data were available, positive lesions were found in 16 patients (26.7%). The overall rebleeding rate was 21.7% during a mean follow up of 17.6 ± 4.7 months. There was no significant difference in the cumulative rebleeding rates between patients with positive and negative CTE results (P = 0.241). All patients who received specific treatments after CTE did not rebleed (0/8). In positive CTE patients, specific treatments significantly reduced the rebleeding rate (P = 0.023).
CTE has a high rate of detecting overt OGIB. However, negative CTE results do not predict lower long-term rebleeding, and such patients with OGIB should be closely observed. In patients with positive CTE, more vigorous management significantly reduces the incidence of rebleeding.
计算机断层肠摄影术（CTE）是一种很有前途的小肠成像方式。然而，CTE 在评估不明原因胃肠道出血（OGIB）中的作用尚未确定。我们研究了 CTE 对 OGIB 的诊断效果，以及基于 CTE 结果的长期预后，特别参考了阴性 CTE 的情况。
共纳入 63 例因 OGIB 而行 CTE 的连续患者，并收集了他们 CTE 前后的临床数据。“特定治疗”定义为直接针对疑似出血原因的治疗，包括止血和手术，而“非特定治疗”定义为贫血的对症治疗。
在可获得长期随访数据的 60 例患者中，16 例（26.7%）发现阳性病变。在平均 17.6±4.7 个月的随访中，总体再出血率为 21.7%。CTE 结果阳性和阴性患者的累积再出血率无显著差异（P=0.241）。所有在 CTE 后接受特定治疗的患者均未再出血（0/8）。在 CTE 阳性患者中，特定治疗显著降低了再出血率（P=0.023）。
CTE 对显性 OGIB 的检出率较高。然而，阴性 CTE 结果并不能预测较低的长期再出血风险，对于此类 OGIB 患者应密切观察。在 CTE 阳性患者中，更积极的管理可显著降低再出血的发生率。
