Zhang Qiang, He Qiong, Liu Jun, Ma Feng, Zhi Fachao, Bai Yang
Hepatogastroenterology. 2013 Nov-Dec;60(128):1885-91.
BACKGROUND/AIMS: Capsule endoscopy (CE) and double-balloon endoscopy (DBE) have their respective advantages and disadvantages of diagnosis of obscure gastrointestinal bleeding (OGIB). Our aim was to evaluate the diagnostic yield and outcome of CE combined with DBE in patients with OGIB.
By searching PubMed, two reviewers identified prospective or retrospective studies comparing CE with DBE in the diagnosis of OGIB. A meta- and pooled-analysis was performed.
In 712 patients with OGIB recruited in the 12 eligible studies, the overall diagnostic yield of CE compared with DBE was similar. In sub-analyses, the diagnostic yields between CE and DBE for vascular lesions, ulcerative/inflammatory lesions and tumors/ neoplasia were also similar, but for fresh blood/clots (CE 21.8% vs. DBE 3.3%, p < 0.00001) and diverticulum (CE 0.6% vs. DBE 3.97%, p = 0.02) did differ significantly. Of 205 patients with OGIB, 148 (72.2%) were detected by CE but not by DBE and 57 (27.8%) were detected by DBE but not by CE. In 52 patients with fresh blood/clots detected by CE, DBE found fresh blood/clots only in one (1.9%) of the 52 patients and made a new or clarified diagnosis in 51 (98.1%).
Each approach detected some lesions not seen by the other. Combined use of CE and DBE in diagnosis of OGIB is better than either modality alone.
背景/目的：胶囊内镜（CE）和双气囊小肠镜（DBE）在不明原因消化道出血（OGIB）的诊断中各有优缺点。我们的目的是评估CE联合DBE对OGIB患者的诊断率及结果。
通过检索PubMed，两名研究者确定了比较CE与DBE诊断OGIB的前瞻性或回顾性研究。进行了荟萃分析和汇总分析。
在12项符合条件的研究中纳入的712例OGIB患者中，CE与DBE的总体诊断率相似。在亚组分析中，CE与DBE对血管病变、溃疡性/炎症性病变和肿瘤/瘤形成的诊断率也相似，但对新鲜血液/血凝块（CE为21.8%，DBE为3.3%，p<0.00001）和憩室（CE为0.6%，DBE为3.97%，p = 0.02）的诊断率确实存在显著差异。在205例OGIB患者中，148例（72.2%）通过CE检测到但未通过DBE检测到，57例（27.8%）通过DBE检测到但未通过CE检测到。在CE检测到的52例有新鲜血液/血凝块的患者中，DBE仅在52例患者中的1例（1.9%）中发现了新鲜血液/血凝块，并在51例（98.1%）中做出了新的或明确的诊断。
每种方法都能检测到另一种方法未发现的一些病变。CE和DBE联合用于OGIB的诊断优于单独使用任何一种方法。
