Shiani Ashok, Nieves Javier, Lipka Seth, Patel Brijesh, Kumar Ambuj, Brady Patrick
Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Therap Adv Gastroenterol. 2016 Jan;9(1):13-8. doi: 10.1177/1756283X15610042.
In patients with obscure gastrointestinal bleeding (OBGIB) capsule endoscopy (CE) is the initial diagnostic procedure of choice. Often patients undergo single balloon enteroscopy (SBE) with both diagnostic and therapeutic intention after CE. Although SBE offers a therapeutic benefit, long procedure times, complexity, and invasiveness are drawbacks. We aimed to evaluate the diagnostic correlation between these two modalities after an initial positive CE finding.
We performed a retrospective review of 418 patients who underwent CE at our institution from January 2010 to May 2014. A total of 95 patients were analyzed after selecting patients that underwent SBE originally after a positive CE result for the evaluation for OGIB. Agreement beyond chance was evaluated using the κ coefficient. A p value less than 5% was considered statistically significant.
The mean age of our population was 65.8 ± 12.2 and it was female predominant: 57/95 (60%). The most frequent positive findings were vascular lesions found on SBE in 31.6% and on CE in 41.1%. There was a strong agreement when identifying active bleeding and clots [κ=0.97; 95% confidence interval (CI) 0.92-1.03; p ⩽ 0.0001], and a moderate agreement when diagnosing vascular lesions (0.41; 95% CI 0.21-0.61; p ⩽ 0.0001). There was fair agreement for ulcers (0.26; 95% CI 0.07-0.59; p = 0.005). There was a low correlation between masses, polyps, and others.
CE still remains the initial test of choice in evaluating stable patients with OBGIB since it has strong-to-fair concordance for the major small bowel findings. However, in cases of severe overt small bowel bleeding, balloon-assisted enteroscopy can be considered the initial procedure of choice since it is therapeutic as well as diagnostic and this approach avoids delays in treatment. Further research should focus on methods to improve interpretation of CE and enhance the ability to evaluate the entire small bowel with SBE.
在不明原因胃肠道出血（OBGIB）患者中，胶囊内镜检查（CE）是首选的初始诊断方法。CE检查后，患者通常会接受单气囊小肠镜检查（SBE），兼具诊断和治疗目的。尽管SBE具有治疗优势，但检查时间长、操作复杂且具有侵入性。我们旨在评估在CE检查首次发现阳性结果后，这两种检查方法之间的诊断相关性。
我们对2010年1月至2014年5月在我院接受CE检查的418例患者进行了回顾性研究。在最初CE检查结果为阳性后接受SBE检查以评估OBGIB的患者中，共选取95例患者进行分析。使用κ系数评估一致性是否超出偶然概率。p值小于5%被认为具有统计学意义。
我们研究人群的平均年龄为65.8±12.2岁，女性占多数：57/95（60%）。最常见的阳性发现是SBE检查发现的血管病变占31.6%，CE检查发现的血管病变占41.1%。在识别活动性出血和血凝块方面有很强的一致性[κ=0.97；95%置信区间（CI）0.92 - 1.03；p⩽0.0001]，在诊断血管病变方面有中度一致性（0.41；95%CI 0.21 - 0.61；p⩽0.0001）。在诊断溃疡方面有一般一致性（0.26；95%CI 0.07 - 0.59；p = 0.005）。在肿物、息肉及其他病变方面相关性较低。
CE仍是评估稳定型OBGIB患者的首选初始检查方法，因为其对主要小肠病变的一致性从中等到强。然而，在严重显性小肠出血的情况下，气囊辅助小肠镜检查可被视为首选初始检查方法，因为它兼具诊断和治疗作用，且这种方法可避免治疗延误。进一步的研究应聚焦于改进CE解读方法以及提高SBE对整个小肠的评估能力。
