Department of Radiology, Medical Center Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands.
Endoscopy. 2012 Jul;44(7):668-73. doi: 10.1055/s-0032-1309386. Epub 2012 Apr 23.
New modalities are available for visualization of the small bowel in patients with possible obscure gastrointestinal bleeding (OGIB), but their performance requires further comparison. This study compared the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy in patients with OGIB, using balloon-assisted enteroscopy (BAE) as the reference standard.
Consecutive consenting patients who were referred for evaluation of OGIB were prospectively included. Patients underwent MRE followed by capsule endoscopy and BAE. Patients with high grade stenosis at MRE did not undergo capsule endoscopy. The reference standard was BAE findings in visualized small-bowel segments and expert panel consensus for segments not visualized during BAE.
Over a period of 26 months, 38 patients were included (20 female [53 %]; mean age 58 years, range 28 - 75 years). Four patients (11 %) did not undergo capsule endoscopy due to high grade small-bowel stenosis at MRE (n = 3; 8 %) or timing issues (n = 1; 3 %). Capsule endoscopy was non-diagnostic in one patient. The reference standard identified abnormal findings in 20 patients (53 %). MRE had sensitivity, specificity, and positive and negative likelihood ratios of 21 %, 100 %, infinity, and 0.79, respectively. The corresponding values for capsule endoscopy were 61 %, 85 %, 4.1, and 0.46. The reference standard and capsule endoscopy did not differ in percent positive findings (P = 0.34), but MRE differed significantly from the reference BAE (P < 0.001). Capsule endoscopy was superior to MRE for detecting abnormalities (P = 0.0015).
Capsule endoscopy performed better than MRE in the detection of small-bowel abnormality in patients with OGIB. MRE may be considered as an alternative for the initial examination in patients with clinical suspicion of small-bowel stenosis.
新的方式可用于可视化可能有隐匿性胃肠道出血（OGIB）的小肠，但它们的性能需要进一步比较。本研究比较了磁共振肠造影术（MRE）和胶囊内镜在 OGIB 患者中的诊断效果，以球囊辅助内镜检查（BAE）为参考标准。
连续同意评估 OGIB 的患者前瞻性纳入。患者接受 MRE 检查，随后进行胶囊内镜和 BAE 检查。MRE 发现高级别狭窄的患者不进行胶囊内镜检查。参考标准是可视化小肠段的 BAE 结果和未可视化段的专家小组共识。
在 26 个月的时间里，共纳入 38 例患者（20 例女性[53%]；平均年龄 58 岁，范围 28-75 岁）。由于 MRE 发现小肠高级别狭窄（n=3；8%）或时间问题（n=1；3%），4 例患者（11%）未进行胶囊内镜检查。1 例患者的胶囊内镜检查结果不可诊断。参考标准在 20 例患者（53%）中发现异常。MRE 的敏感性、特异性、阳性和阴性似然比分别为 21%、100%、无穷大和 0.79。胶囊内镜的相应值为 61%、85%、4.1 和 0.46。参考标准和胶囊内镜在阳性发现百分比上没有差异（P=0.34），但 MRE 与参考 BAE 有显著差异（P<0.001）。胶囊内镜在检测异常方面优于 MRE（P=0.0015）。
胶囊内镜在检测 OGIB 患者小肠异常方面优于 MRE。MRE 可考虑作为临床怀疑小肠狭窄患者初始检查的替代方法。
