Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy.
Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy.
Clin Res Hepatol Gastroenterol. 2021 Jan;45(1):101409. doi: 10.1016/j.clinre.2020.03.011. Epub 2020 Mar 31.
Capsule endoscopy has been considered the first-line approach for the investigation of obscure gastro-intestinal bleeding since its approval in 2001. Our study aims to evaluate the diagnostic yield of capsule endoscopy in the investigation of this condition. We also analyse the incidence of non-small-bowel lesions missed after conventional endoscopy and later detected by capsule endoscopy in patients with suspected obscure bleeding.
A total of 290 patients with negative conventional endoscopy referred to our centre to undergo a capsule endoscopy examination for the investigation of obscure gastro-intestinal bleeding. We considered as non-small-bowel lesions those outside the tract between the second duodenal portion and the ileocecal valve. We also looked for actively bleeding lesions at the time of the exam.
Intestinal preparation was good, adequate or poor in 74.1%, 8.4%, and 17.5% of the tests, respectively. Caecum was reached in 92.4%. Capsule retention occurred in 0.7%. Mean small bowel transit time was 5hours and 13minutes. Diagnostic yield was 73.8%. An actively bleeding lesion was noticed in 39.3% of positive tests. Capsule endoscopy revealed clinically significant non-small-bowel lesions missed at gastroscopy or colonoscopy in 30.3% of patients, 43.2% of which were bleeding.
Capsule endoscopy has high diagnostic yield and safety in the investigation of obscure gastro-intestinal bleedings. Given the high percentage of non-small-bowel lesions detected, it may be appropriate to consider an endoscopic second look before performing a capsule endoscopy study.
自 2001 年胶囊内镜获得批准以来，它已被认为是不明胃肠道出血的一线检查方法。我们的研究旨在评估胶囊内镜在这种情况下的诊断效果。我们还分析了在疑似不明原因出血的患者中，常规内镜检查后遗漏的非小肠病变，以及后来通过胶囊内镜检测到的病变的发生率。
共有 290 例常规内镜检查阴性的患者因不明胃肠道出血被转诊至我们中心进行胶囊内镜检查。我们将不在十二指肠第二段和回盲瓣之间的通道内的病变定义为非小肠病变。我们还在检查时寻找正在出血的病变。
肠道准备良好、充足和不佳的检查分别占 74.1%、8.4%和 17.5%。92.4%的患者到达盲肠。胶囊滞留发生率为 0.7%。平均小肠转运时间为 5 小时 13 分钟。诊断效果为 73.8%。39.3%的阳性检查发现有正在出血的病变。胶囊内镜显示在 30.3%的患者中发现了临床上有意义的、在胃镜或结肠镜检查中遗漏的非小肠病变，其中 43.2%为出血性病变。
胶囊内镜在不明胃肠道出血的检查中具有较高的诊断效果和安全性。鉴于检测到的非小肠病变的比例较高，在进行胶囊内镜检查之前，考虑进行内镜二次检查可能是合适的。
