急诊气囊辅助小肠镜检查对显性不明原因消化道出血的再出血及短期死亡率有何影响？

Does urgent balloon-assisted enteroscopy impact rebleeding and short-term mortality in overt obscure gastrointestinal bleeding?

作者信息

Silva João Carlos, Pinho Rolando, Ponte Ana, Rodrigues Adélia, Rodrigues Jaime, Gomes Ana Catarina, Afecto Edgar, Carvalho João

机构信息

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Porto, Portugal.

出版信息

Scand J Gastroenterol. 2020 Oct;55(10):1243-1247. doi: 10.1080/00365521.2020.1813800. Epub 2020 Sep 10.

DOI:10.1080/00365521.2020.1813800

PMID:32907435

Abstract

BACKGROUND AND AIMS

The diagnostic yield (DY) and therapeutic yield (TY) of balloon-assisted enteroscopy (BAE) in overt obscure gastrointestinal bleeding (OGIB) is higher in the first 72 h. This study aimed to evaluate if this higher DY and TY after urgent BAE impacted the rebleeding rate, time to rebleed and short-term mortality.

METHODS

Retrospective cohort-study, which consecutively included all patients submitted to BAE for overt OGIB, between 2010 and 2019. Patients were distributed in 2 groups: (1) Urgent BAE; (2) Non-urgent BAE. Rebleeding was defined as an Hb drop >2 g/dL, need for transfusional support or presence of melena/hematochezia.

RESULTS

Fifty-four patients were included, of which 17 (31.5%) were submitted to BAE in the first 72 h. DY and TY of urgent BAE (DY 88.2%; = 15; TY 94.1%; = 16) was higher compared to non-urgent BAE (DY 59.5%; = 22; TY 45.9%; = 17) (DY = .03) (TY = .001). The rebleeding rate at 1, 2, and 5 years was 32.0%, 34.0%and 37.0%, respectively. Rebleeding was lower after urgent BAE (17.6%; = 3) compared to non-urgent BAE (45.9%; = 17) ( = .04). Rebleeding tended to occurr earlier in non-urgent BAE, being at 6-months (32.5%) and 36 months (41.3%) ( = .05). OGIB related 30-day mortality was 5.4% ( = 2) for non-urgent BAE and 0% for urgent BAE ( = .5).

CONCLUSION

Urgent BAE might be associated with higher DY and TY with lower rebleeding and trend toward higher rebleeding-free time.

摘要

背景与目的

在显性不明原因胃肠道出血（OGIB）中，球囊辅助小肠镜检查（BAE）在最初72小时内的诊断率（DY）和治疗率（TY）更高。本研究旨在评估紧急BAE后较高的DY和TY是否会影响再出血率、再出血时间和短期死亡率。

方法

回顾性队列研究，连续纳入2010年至2019年间因显性OGIB接受BAE检查的所有患者。患者分为两组：（1）紧急BAE组；（2）非紧急BAE组。再出血定义为血红蛋白下降>2g/dL、需要输血支持或出现黑便/便血。

结果

共纳入54例患者，其中17例（31.5%）在最初72小时内接受了BAE检查。紧急BAE的DY（88.2%；n = 15）和TY（94.1%；n = 16）高于非紧急BAE（DY 59.5%；n = 22；TY 45.9%；n = 17）（DY = 0.03）（TY = 0.001）。1年、2年和5年的再出血率分别为32.0%、34.0%和37.0%。紧急BAE后的再出血率（17.6%；n = 3）低于非紧急BAE（45.9%；n = 17）（P = 0.04）。非紧急BAE的再出血倾向于更早发生，分别在6个月时（32.5%）和36个月时（41.3%）（P = 0.05）。非紧急BAE的OGIB相关30天死亡率为5.4%（n = 2），紧急BAE为0%（P = 0.5）。