食管胶囊内镜在儿童和青年门脉高压患者中的应用。
Esophageal Capsule Endoscopy in Children and Young Adults With Portal Hypertension.
机构信息
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
出版信息
J Pediatr Gastroenterol Nutr. 2019 Dec;69(6):641-647. doi: 10.1097/MPG.0000000000002455.
OBJECTIVES
Variceal hemorrhage (VH) is a serious complication of portal hypertension (PH). We evaluated the feasibility, safety, and clinical impact of esophageal capsule endoscopy (ECE) in pediatric and young adult patients with known or suspected PH.
METHODS
Children and young adults with PH at Boston Children's Hospital (2005-2017) were offered ECE for variceal screening or surveillance. Patient histories, ECE findings, and clinical outcomes were reviewed retrospectively.
RESULTS
One hundred and forty-nine ECE studies were performed in 98 patients (57.1% male patients) using 3 ECE devices for variceal screening (66.5%) or surveillance (33.5%). Three readers interpreted the studies (88.3%, 10.3%, and 1.4%, respectively). Median age was 16 years (IQR 13.7-18.5). One hundred and three ECE studies involved patients <18 years (69.1%). Fifteen patients (29 ECE studies) had a gastrointestinal (GI) bleeding (GIB) history, 5 in the preceding 12 months.Sixty-two ECE studies (44.9%) detected varices: 59 esophageal (40 small, 19 medium/large), 17 gastric, 6 duodenal. Other findings included: portal gastropathy (25, 18.1%), esophagitis (20, 14.5%), ulcers (5, 3.6%), erosions (31, 22.5%), heterotopic tissue (13, 9.4%), blood flecks (23, 16.7%), and mucosal scars (17, 12.3%). There were 2 transient capsule retentions and no major adverse events.ECE led to follow-up EGD in 11 (7 variceal banding) and medication initiation in 12 (4 proton-pump inhibitor, 7 nonselective beta blocker, 2 other) cases. Four patients had GIB within 12 months of ECE.
CONCLUSION
ECE is a feasible alternative to EGD for screening and surveillance of esophageal varices in children and young adults.
目的
静脉曲张出血（VH）是门静脉高压（PH）的严重并发症。我们评估了食管胶囊内镜（ECE）在已知或疑似 PH 的儿科和年轻成年患者中的可行性、安全性和临床影响。
方法
2005 年至 2017 年，在波士顿儿童医院为 PH 患儿和年轻成人提供 ECE 进行静脉曲张筛查或监测。回顾性审查患者病史、ECE 结果和临床结局。
结果
98 例患者共进行了 149 次 ECE 检查（57.1%为男性），使用 3 种 ECE 设备进行静脉曲张筛查（66.5%）或监测（33.5%）。三位读者分别对研究进行了解读（分别为 88.3%、10.3%和 1.4%）。中位年龄为 16 岁（IQR 13.7-18.5）。103 例 ECE 研究涉及年龄<18 岁的患者（69.1%）。15 例（29 次 ECE）有胃肠道（GI）出血（GIB）病史，其中 5 例在过去 12 个月内发生。62 次 ECE 检查（44.9%）发现静脉曲张：59 例食管（40 例小，19 例中/大），17 例胃，6 例十二指肠。其他发现包括：门脉性胃病（25 例，18.1%）、食管炎（20 例，14.5%）、溃疡（5 例，3.6%）、糜烂（31 例，22.5%）、异位组织（13 例，9.4%）、血斑（23 例，16.7%）和黏膜疤痕（17 例，12.3%）。有 2 例胶囊短暂滞留，无重大不良事件。ECE 后 11 例（7 例行静脉曲张套扎）进行了后续 EGD，12 例（4 例质子泵抑制剂，7 例非选择性β受体阻滞剂，2 例其他）开始了药物治疗。4 例患者在 ECE 后 12 个月内发生 GIB。
结论
ECE 是儿童和年轻成人食管静脉曲张筛查和监测的替代 EGD 方法。
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