Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Clin Gastroenterol Hepatol. 2012 Aug;10(8):910-6. doi: 10.1016/j.cgh.2012.04.020. Epub 2012 May 18.
BACKGROUND & AIMS: Antegrade and retrograde enteroscopy are useful for evaluating the proximal and distal small bowel, respectively. We compared the diagnostic yield, therapeutic yield, and complications of antegrade and retrograde enteroscopy.
We performed a retrospective review of a prospectively maintained database of patients who underwent small-bowel enteroscopy at our institution from January 2008 to August 2009. All enteroscopies were performed using single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or spiral enteroscopy (SE). A total of 250 enteroscopies were performed; 182 were antegrade (91 SBE, 52 DBE, and 39 SE) and 68 were retrograde (23 SBE, 37 DBE, and 8 SE). The mean age of the patients was 61.5 ± 15.8 years.
The most common indication for small-bowel endoscopy was obscure gastrointestinal bleeding (n = 83). The diagnostic yield was significantly higher for antegrade than retrograde enteroscopy (63.7% vs 39.7%; P < .001). Antegrade procedures were of shorter duration than retrograde enteroscopy (44.3 ± 22.0 vs 58.9 ± 29.7 min; P < .001), and the mean depth of maximal insertion was significantly greater with antegrade endoscopy (231.8 ± 122.1 vs 103.4 ± 102.8 cm; P < .001). The therapeutic yield also was significantly higher for anterograde enteroscopy than retrograde enteroscopy (55.5% vs 44.1%; P < .001). There were no significant differences in complications.
Antegrade enteroscopy appears to provide a higher diagnostic and therapeutic yield than retrograde enteroscopy in patients with suspected small-bowel disease.
经口和经肛推进式小肠镜分别适用于近端和远端小肠的检查。本研究旨在比较经口和经肛推进式小肠镜的诊断和治疗效果及并发症。
我们对 2008 年 1 月至 2009 年 8 月期间在我院接受小肠镜检查的患者前瞻性数据库进行了回顾性分析。所有小肠镜检查均采用单气囊小肠镜（SBE）、双气囊小肠镜（DBE）或螺旋小肠镜（SE）进行。共进行了 250 例小肠镜检查，其中 182 例为经口推进式（91 例 SBE、52 例 DBE 和 39 例 SE），68 例为经肛推进式（23 例 SBE、37 例 DBE 和 8 例 SE）。患者平均年龄为 61.5±15.8 岁。
最常见的小肠镜检查适应证为不明原因胃肠道出血（n=83）。经口推进式小肠镜的诊断率显著高于经肛推进式小肠镜（63.7% vs 39.7%；P<.001）。经口推进式小肠镜的操作时间显著短于经肛推进式小肠镜（44.3±22.0 vs 58.9±29.7 min；P<.001），且经口推进式小肠镜的最大插入深度也显著更深（231.8±122.1 vs 103.4±102.8 cm；P<.001）。经口推进式小肠镜的治疗率也显著高于经肛推进式小肠镜（55.5% vs 44.1%；P<.001）。两种方式的并发症发生率无显著差异。
对于疑似小肠疾病的患者，经口推进式小肠镜在诊断和治疗效果方面似乎优于经肛推进式小肠镜。
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