Tharian Benjamin, Caddy Grant, Tham Tony Ck
Benjamin Tharian, Grant Caddy, Tony CK Tham, Division of Gastroenterology, Ulster Hospital, Dundonald BT16 1RH, Belfast, Northern Ireland, United Kingdom.
World J Gastrointest Endosc. 2013 Oct 16;5(10):476-86. doi: 10.4253/wjge.v5.i10.476.
Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel. Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist, aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy (WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy (DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy (DBE), single balloon enteroscopy (SBE) and more recently spiral enteroscopy (SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn's. These excluded topics already have comprehensive reviews. Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D (based on expert opinion). The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial's in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.
克罗恩病（CD）是一种胃肠道的慢性炎症性疾病，可导致继发于透壁性炎症的炎症、狭窄和瘘管形成。诊断依赖于临床病史、异常的实验室参数、胃肠道内特征性的放射学和内镜改变，最重要的是支持性的组织学检查。本文主要面向普通胃肠病学家和其他感兴趣的医生。由于小肠难以触及，小肠克罗恩病的管理一直不太理想且受限。近来，小肠镜检查有了显著复兴，从而扩大了内镜医师的检查范围，有助于诊断并能在小肠进行治疗干预。放射学成像被用作可视化小肠的一线检查方法。如果临床怀疑度高，尽管上述检查结果正常，仍会使用无线胶囊内镜（WCE）来排除浅表和早期疾病。随后根据情况进行推进式小肠镜检查或器械辅助小肠镜检查（DAE）。已发现这种方法最具成本效益且侵入性最小。DAE包括气囊辅助小肠镜检查、[双气囊小肠镜检查（DBE）、单气囊小肠镜检查（SBE）以及最近的螺旋小肠镜检查（SE）]。本综述不会涵盖小肠镜检查的各种其他适应证、小肠的放射学检查以及WCE，仅局限于小肠克罗恩病中的小肠镜检查。这些被排除的主题已有全面的综述。比较各种检查方法的随机对照试验所提供的证据有限，充其量被视为C级或D级（基于专家意见）。证据表明，所有三种DAE检查方法的插入深度、诊断和治疗效果以及并发症发生率相当，不过由于全小肠镜检查率较高，大多数人更倾向于DBE。SE比DBE更快，但全小肠镜检查率较低。SBE的操作时间更快且仍在发展，但目前是最少使用的DAE检查方法。未来更大规模的前瞻性随机对照试验可能有助于我们了解一些未解决的问题，包括BAE在小肠筛查中的作用以及小肠克罗恩病中主要小肠镜检查类型之间的比较研究。
