Bandorski Dirk, Kurniawan Niehls, Baltes Peter, Hoeltgen Reinhard, Hecker Matthias, Stunder Dominik, Keuchel Martin
Dirk Bandorski, Matthias Hecker, University of Giessen and Marburg Lung Center, Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany.
World J Gastroenterol. 2016 Dec 7;22(45):9898-9908. doi: 10.3748/wjg.v22.i45.9898.
Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn's disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging (MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.
在过去15年里，视频胶囊内镜检查（VCE）的应用领域不断扩大。尽管许多禁忌症已得到重新审视，但仍需考虑一些预防措施。已知的胃肠道狭窄是VCE的明确禁忌症，除非手术已安排妥当或至少已被视为一种可选的治疗方式。在狭窄发生率较高的患者中，如已确诊克罗恩病、有肠梗阻临床体征、既往接受过放疗或小肠手术切除的患者，先行使用可自行溶解的通畅性胶囊进行检查可克服这一禁忌症。对于吞咽障碍患者，应考虑内镜下放置胶囊以避免误吸。如果实时观察显示通过延迟，食管或胃动力障碍可能需要内镜下胶囊输送或应用促动力药。对于孕妇，VCE应仅限于分娩后无法推迟诊断的紧急情况，因为目前尚无安全性数据。有理论和临床证据表明，植入心脏装置（如起搏器、心脏复律器或左心辅助装置）的患者，尽管制造商仍将其列为禁忌症，但仍可安全地接受VCE检查。2岁及以上儿童已安全地接受了VCE检查。尽管视频胶囊在磁共振成像（MRI）中未被证明是安全的，但已有首例患者在接受MRI检查时意外发现体内有胶囊的报告，结果显示有磁化伪影，但无临床损害迹象。
