Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea.
Eur Radiol. 2012 Jun;22(6):1159-66. doi: 10.1007/s00330-011-2374-1. Epub 2012 Jan 22.
The aim of the present study was to evaluate the role of capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) after negative computed tomographic (CT) enterography.
We retrospectively included 30 patients with OGIB who received capsule endoscopy after negative CT enterography. The median age of the patients was 60 years, and 60% of patients were male. The median follow-up duration was 8 months. Overt bleeding was 60%, and occult bleeding was 40%.
Based on capsule endoscopy results, a definitive diagnosis was made for 17 patients (57%): ulcer in nine patients (30%), active bleeding with no identifiable cause in five (17%), angiodysplasia in two (7%) and Dieulafoy's lesion in one (3%). Two patients with jejunal ulcers were diagnosed with Crohn's disease. Seven patients (41%) with positive capsule endoscopy received double balloon enteroscopy and two patients (12%) received steroid treatment for Crohn's disease. Patients with overt bleeding, a previous history of bleeding, or who received large amounts of blood transfusions were more likely to show positive capsule endoscopy.
Capsule endoscopy showed high diagnostic yields in patients with OGIB after negative CT enterography and may help to provide further therapeutic plans for patients with OGIB and negative CT enterography.
• CT enterography has been widely used in evaluating obscure gastrointestinal bleeding (OGIB). • Capsule endoscopy showed high diagnostic yield for OGIB after negative CT enterography. • Negative CT enterography does not exclude important causes of small bowel bleeding. • Most lesions missed at CT-enterography are flat and can be detected by capsule endoscopy.
本研究旨在评估胶囊内镜在 CT 肠造影检查阴性的不明原因胃肠道出血（OGIB）患者中的作用。
我们回顾性纳入了 30 例 CT 肠造影检查阴性的 OGIB 患者，这些患者均接受了胶囊内镜检查。患者的中位年龄为 60 岁，60%为男性。中位随访时间为 8 个月。显性出血占 60%，隐性出血占 40%。
根据胶囊内镜检查结果，17 例患者（57%）明确诊断：9 例（30%）溃疡、5 例（17%）无明显原因的活动性出血、2 例（7%）血管畸形和 1 例（3%）Dieulafoy 病变。2 例空肠溃疡患者被诊断为克罗恩病。7 例（41%）胶囊内镜阳性的患者接受了双气囊小肠镜检查，2 例（12%）克罗恩病患者接受了激素治疗。显性出血、既往出血史或大量输血的患者更有可能出现胶囊内镜阳性。
胶囊内镜对 CT 肠造影检查阴性的 OGIB 患者具有较高的诊断率，可能有助于为 CT 肠造影检查阴性的 OGIB 患者提供进一步的治疗方案。
CT 肠造影已广泛用于评估不明原因胃肠道出血（OGIB）。
胶囊内镜对 CT 肠造影检查阴性的 OGIB 患者具有较高的诊断率。
CT 肠造影检查阴性并不能排除小肠出血的重要原因。
CT 肠造影检查漏诊的大多数病变为平坦病变，可通过胶囊内镜检测。
