Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
Rev Esp Enferm Dig. 2012 Apr;104(4):190-6. doi: 10.4321/s1130-01082012000400004.
in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level.
evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding.
we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively.
with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy´s lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively.
intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.
在 21 世纪，随着胶囊内镜和气囊辅助式小肠镜的出现，小肠内镜检查发生了革命性变化。与术中内镜检查相比，术中内镜检查在 20 世纪是金标准，但由于其相关的难度和发病率，该技术已退居二线。
评估术中内镜检查在不明原因胃肠道出血患者中的实际作用，并评估其诊断和治疗价值。
我们对 19 例（男性 11 例；平均年龄：66.5 ± 15.3 岁）接受 21 例 IOE 检查以明确不明原因胃肠道出血的患者进行了回顾性研究。10 例患者进行了胶囊内镜检查，5 例患者进行了双气囊小肠镜检查。
通过术中内镜检查，79%的患者发现了小肠出血病变，94%的患者发现了胃肠道出血病变。小肠镜检查结果包括：血管扩张症（n = 6）、溃疡（n = 4）、小肠迪厄拉富瓦病变（n = 2）、吻合口血管出血（n = 1）、多发海绵状血管瘤（n = 1）和异位空肠静脉曲张出血（n = 1）。胶囊内镜与术中内镜检查的一致性为 70%。对术中内镜检查阳性的患者，77.8%采用内镜和/或手术治疗，在平均 21 个月的随访中，再出血率为 21.4%。与该操作相关的死亡率和术后并发症发生率分别为 5%和 21%。
在选择的不明原因胃肠道出血患者中，术中内镜检查仍然是一种有价值的工具，其诊断率较高，大多数患者可进行内镜和/或手术治疗。然而，由于其为有创性操作，具有一定的死亡率和发病率，因此对其使用的指征进行精确的判断是不可或缺的。
