磁共振肠造影与胶囊内镜联合气囊辅助推进式小肠镜检查在不明原因胃肠道出血中的比较。

Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding.

机构信息

Department of Radiology, Medical Center Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands.

出版信息

Endoscopy. 2012 Jul;44(7):668-73. doi: 10.1055/s-0032-1309386. Epub 2012 Apr 23.

DOI:10.1055/s-0032-1309386

PMID:22528671

Abstract

BACKGROUND AND STUDY AIMS

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.

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

背景和研究目的

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。

患者和方法

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。

结果

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）。