Albrecht Heinz, Hagel Wolfgang H, Hagel Alexander F, Neurath Markus F, Raithel Martin
Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany.
J Gastrointestin Liver Dis. 2016 Mar;25(1):33-7. doi: 10.15403/jgld.2014.1121.251.2be.
Double-balloon enteroscopy (DBE) is a sensitive and safe procedure for the detection and treatment of mid-gastrointestinal bleeding (MGIB). It combines the possibility of a panenteroscopy with the immediate chance for intervention. This study evaluates the yield of DBE for the detection and treatment of MGIB in an unselected patient cohort.
In a five-year period a total of 119 DBEs were carried out on 62 patients due to MGIB. Inclusion criteria were hematochezia, melena, anemia, positive hemoccult-test and iron deficiency. All pre-existing diseases or comorbidities were evaluated. Two main statistical methodologies were used in data analysis: descriptive statistics to describe the basic features of our data and Fisher's exact test for comparisons of proportions.
The diagnostic yield was 69% (pathological findings in 43/62 patients) and the main diagnoses in all DBE-procedures were angiodysplasia (22%, 26/119 DBE), followed by lipid islets (18%, 21/119 DBE). In all patients with lipid islets this diagnosis was significantly connected with cardiovascular diseases. The combination of lipid islets and a relevant bleeding source appeared in 79% of the 19 patients with these findings. Of these, 53% had to be treated due to the bleeding event. The overall therapeutic intervention rate was 58%. Serious complications such as perforation or pancreatitis did not occur.
Double-balloon enteroscopy as the gold standard for small bowel investigation in MGIB confirmed its high diagnostic yield in an unselected cohort of patients. A new strong combination of lipid islets with cardiovascular disease was revealed, with a high incidence of angiectasia bleeding. This combination should be evaluated in more detail as a new risk factor for MGIB, and should be regarded in this population when therapeutic anticoagulation is needed.
双气囊小肠镜检查(DBE)是检测和治疗中消化道出血(MGIB)的一种敏感且安全的方法。它将全小肠镜检查的可能性与即时干预的机会相结合。本研究评估DBE在未经选择的患者队列中检测和治疗MGIB的效果。
在五年期间,因MGIB对62例患者共进行了119次DBE检查。纳入标准为便血、黑便、贫血、潜血试验阳性和缺铁。对所有既往疾病或合并症进行了评估。数据分析中使用了两种主要的统计方法:描述性统计以描述我们数据的基本特征,以及Fisher精确检验用于比例比较。
诊断率为69%(43/62例患者有病理发现),所有DBE检查中的主要诊断为血管发育异常(22%,26/119次DBE),其次是脂质岛(18%,21/119次DBE)。在所有有脂质岛的患者中,该诊断与心血管疾病显著相关。在19例有这些发现的患者中,79%出现了脂质岛与相关出血源的组合。其中,53%因出血事件必须接受治疗。总体治疗干预率为58%。未发生穿孔或胰腺炎等严重并发症。
双气囊小肠镜检查作为MGIB中小肠检查的金标准,在未经选择的患者队列中证实了其高诊断率。揭示了脂质岛与心血管疾病的一种新的强关联,血管扩张性出血发生率高。这种组合应作为MGIB的一种新的危险因素进行更详细的评估,并且在需要治疗性抗凝的人群中应予以考虑。