Department of Internal Medicine.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
J Clin Gastroenterol. 2021 Oct 1;55(9):792-797. doi: 10.1097/MCG.0000000000001426.
Since 2001, device-assisted enteroscopy (DAE) has revolutionized the diagnostic and therapeutic capabilities for managing small bowel pathology. Though commonly performed, there have been no recent large studies to assess the use, yield, and risks of DAE and none that include all 3 DAE modalities. We hypothesized that DAE is safe with high diagnostic and therapeutic yields achieved within reasonable procedure duration and here we present a large retrospective multicenter US study evaluating the use, yield, and complications of DAE.
After obtaining institutional review board approval, electronic records were used to identify all DAE's performed for luminal small bowel evaluation in adult patients at 4 US referral centers (Duke University Medical Center, New York University Langone Medical Center, Louisiana State University Health Sciences Center, and University of Massachusetts Medical Center) from January 1, 2014 to January 1, 2019. Electronic medical records were reviewed to collect and analyze a variety of procedure-related outcomes. Using the data pooled across centers, descriptive statistics were generated for the patient and procedure-related characteristics and outcomes; relationships between characteristics and outcomes were explored.
A total of 1787 DAE's were performed over this 5-year period (392 at Duke University Medical Center, 887 at Louisiana State University Health Sciences Center, 312 at New York University Langone Medical Center, and 195 at University of Massachusetts Medical Center). Of these, there were 1017 (57%) double-balloon, 391 (29%) single-balloon, and 378 (21%) spiral enteroscopies. The mean age of patients undergoing DAE was 66 years and 53% of examinations were performed on women; 18% of patients in the cohort underwent >1 DAE over this time span. A total of 53% of examinations were performed for suspected small bowel bleeding, 31% were directly guided by video capsule endoscopy findings and 8% were performed for abnormal imaging. A total of 85% of examinations used an antegrade approach and DAE took a mean of 45 minutes to complete; 76% of examinations revealed abnormal findings, with vascular, inflammatory, and neoplastic findings seen in 49%, 17%, and 15% of the cohort, respectively. Older age was significantly associated with any abnormal finding, including arteriovenous malformations (P<0.0001); 50% of examinations included a therapeutic maneuver, most commonly argon plasma coagulation/cautery (43%). There were complications in 16 examinations (0.9%) including 2 perforations (0.1%), 6 cases with bleeding (0.3%) and 1 episode of pancreatitis (0.1%).
DAE is most commonly performed to evaluate suspected small bowel bleeding and is commonly directed by video capsule findings. DAE is safe, has a high diagnostic yield, with 76% of examinations showing abnormal findings, and frequently features therapeutic maneuvers. Advancing age is associated with abnormal findings on DAE.
自 2001 年以来，设备辅助的小肠镜检查（DAE）彻底改变了管理小肠病理学的诊断和治疗能力。虽然已普遍开展，但最近尚无大型研究来评估 DAE 的使用、效果和风险，也没有研究包括所有 3 种 DAE 方式。我们假设 DAE 是安全的，在合理的手术时间内可获得较高的诊断和治疗效果，在此我们介绍一项大型回顾性多中心美国研究，评估 DAE 的使用、效果和并发症。
获得机构审查委员会批准后，使用电子病历在 4 个美国转诊中心（杜克大学医学中心、纽约大学朗格尼医学中心、路易斯安那州立大学健康科学中心和马萨诸塞大学医疗中心）中检索 2014 年 1 月 1 日至 2019 年 1 月 1 日期间用于成人患者腔内腔镜小肠评估的所有 DAE。对电子病历进行了审查，以收集和分析各种与手术相关的结果。使用跨中心汇集的数据，对患者和手术相关特征和结果进行描述性统计；探讨了特征与结果之间的关系。
在这 5 年期间共进行了 1787 例 DAE（杜克大学医学中心 392 例，路易斯安那州立大学健康科学中心 887 例，纽约大学朗格尼医学中心 312 例，马萨诸塞大学医疗中心 195 例）。其中，双气囊 1017 例（57%），单气囊 391 例（29%），螺旋小肠镜 378 例（21%）。接受 DAE 的患者平均年龄为 66 岁，53%的检查为女性；在此期间，该队列中有 18%的患者进行了 >1 次 DAE。53%的检查是为了怀疑小肠出血，31%是直接根据视频胶囊内镜检查结果进行的，8%是为了异常影像学检查进行的。85%的检查采用了逆行方法，DAE 平均需要 45 分钟完成；76%的检查显示异常发现，血管、炎症和肿瘤病变分别占该队列的 49%、17%和 15%。年龄较大与任何异常发现显著相关，包括动静脉畸形（P<0.0001）；50%的检查包括治疗操作，最常见的是氩等离子体凝固/电灼（43%）。16 例（0.9%）检查出现并发症，包括 2 例穿孔（0.1%），6 例出血（0.3%）和 1 例胰腺炎（0.1%）。
DAE 最常用于评估疑似小肠出血，通常由胶囊内镜检查结果指导。DAE 是安全的，具有较高的诊断效果，76%的检查显示异常发现，并且经常需要进行治疗操作。年龄增长与 DAE 的异常发现相关。
