Liu Yipin, Jiang Weiwei, Chen Guoxun, Li Yanqing
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong Province 250012, China.
Department of Gastroenterology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province 264000, China.
Gastroenterol Res Pract. 2019 Aug 26;2019:9026278. doi: 10.1155/2019/9026278. eCollection 2019.
This study assesses the diagnostic performance of emergency single-balloon enteroscopy (SBE) for obscure gastrointestinal bleeding (OGIB) under general anesthesia versus conscious sedation.
The data of 102 OGIB in-patients from June 2015 to June 2018 were retrospectively analyzed. The diagnosis and detection rates and adverse events were calculated overall and in relation to age, gender, type of operation and anesthesia, bleeding type, different times of examination, and SBE route. All statistical analyses were performed using SPSS 24.0, and the diagnosis and detection rates were compared using the Chi-square test.
Among the 102 patients, 66 patients had positive findings, while 11 patients had suspected positive findings, and the diagnosis and detection rates were 64.7% and 75.5%, respectively. Ulcers (19.6%) and tumors (16.7%) were the most common causes of OGIB. There were no statistical differences in diagnosis and detection rates between the ages of ≥60 and <60 and between different genders. Patients with emergency SBE had higher diagnosis and detection rates (68.6% 35.3%, = 0.023; 80.0% 47.1%, = 0.016, respectively), when compared with nonemergency SBE patients. The diagnosis rate at 24 hours was higher than that at 2-7 days and one week (88.0% 61.5%, = 0.030; 88.0% 53.8%, = 0.007). For overt bleeding, the difference in diagnosis rates at 24 hours, 2-7 days, and one week was statistically significant (100.0% 57.1%, = 0.006; 100.0% 57.1%, = 0.006). For occult bleeding, the pairwise comparison revealed no statistical difference. Patients with general anesthesia had a higher detection rate, when compared to patients with conscious sedation (87.9% 63.9%, = 0.004). In addition, adverse events under general anesthesia were lower, when compared to adverse events under conscious sedation (28.8% 69.4%, = 0.020). There was no significant difference in adverse events at the different time points ( > 0.05).
Emergency SBE under general anesthesia achieves higher diagnosis and detection rates, and fewer adverse events under conscious sedation, when compared to nonemergency SBE, regardless of the route. For patients with overt bleeding, it is easier to find lesions by emergency SBE within 24 hours.
本研究评估了全身麻醉与清醒镇静下急诊单气囊小肠镜检查（SBE）对不明原因消化道出血（OGIB）的诊断性能。
回顾性分析了2015年6月至2018年6月期间102例OGIB住院患者的数据。总体及按年龄、性别、手术和麻醉类型、出血类型、不同检查时间以及SBE途径计算诊断率、检出率和不良事件。所有统计分析均使用SPSS 24.0进行，诊断率和检出率采用卡方检验进行比较。
102例患者中，66例有阳性发现，11例有疑似阳性发现，诊断率和检出率分别为64.7%和75.5%。溃疡（19.6%）和肿瘤（16.7%）是OGIB最常见的原因。≥60岁和＜60岁患者以及不同性别患者之间的诊断率和检出率无统计学差异。与非急诊SBE患者相比，急诊SBE患者的诊断率和检出率更高（分别为68.6%对35.3%，P = 0.023；80.0%对47.1%，P = 0.016）。24小时时的诊断率高于2 - 7天和1周时（88.0%对61.5%，P = 0.030；88.0%对53.8%，P = 0.007）。对于显性出血，24小时、2 - 7天和1周时的诊断率差异有统计学意义（100.0%对57.1%，P = 0.006；100.0%对57.1%，P = 0.006）。对于隐性出血，两两比较无统计学差异。与清醒镇静患者相比，全身麻醉患者的检出率更高（87.9%对63.9%，P = 0.004）。此外，与清醒镇静下的不良事件相比，全身麻醉下的不良事件更低（28.8%对69.4%，P = 0.020）。不同时间点的不良事件无显著差异（P＞0.05）。
与非急诊SBE相比，无论途径如何，全身麻醉下的急诊SBE诊断率和检出率更高，清醒镇静下的不良事件更少。对于显性出血患者，急诊SBE在24小时内更容易发现病变。
