Zhao Ran, Nakamura Masanao, Wu Shan, Uchida Genta, Yamamura Takeshi, Gao Yun-Jie, Goto Hidemi, Fujishiro Mitsuhiro, Ge Zhi-Zheng
Division of Gastroenterology and Hepatology, School of Medicine, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Jiao Tong University, Renji Hospital, Shanghai, China.
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
J Gastroenterol Hepatol. 2021 Sep;36(9):2540-2548. doi: 10.1111/jgh.15491. Epub 2021 Apr 14.
Video capsule endoscopy (VCE) is a first-line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients.
A total of 997 patients that underwent VCE at Renji Hospital and Nagoya University from May 15, 2002, to December 28, 2016, were included in this study. We matched patients that underwent early VCE within 14 days of bleeding (early group, n = 678) to patients that did not (late group, n = 319) via 1:1 propensity score matching (PSM). We then compared VCE diagnostic rates and the prevalence of post-VCE rebleeding in patients with initial negative VCE findings within 1 year between these groups before and after PSM.
Following PSM, early VCE was associated with a significantly higher rate of OGIB diagnosis (56.4% vs 45.5%, P = 0.001) and with a significantly lower incidence of rebleeding within 1 year following treatment (24.7% vs 36.7%, P = 0.041). In univariate and multivariate analyses, VCE timing (odds ratio 0.648; 95% confidence interval 0.496-0.847, P = 0.001 and odds ratio 0.666; 95% confidence interval 0.496-0.894, P = 0.007, respectively) was found to be linked with a higher rate of positive findings.
Early VCE can improve the reliability of OGIB diagnosis while also reducing rates of post-VCE rebleeding. This suggests that timely and accurate diagnosis can help to improve OGIB patient treatment and prognosis.
视频胶囊内镜检查（VCE）是诊断不明原因胃肠道出血（OGIB）的一线检查方法。对于此类诊断性评估的时机，目前观点尚不明确。我们旨在探讨早期VCE在OGIB患者中的作用。
本研究纳入了2002年5月15日至2016年12月28日期间在仁济医院和名古屋大学接受VCE检查的997例患者。我们通过1:1倾向评分匹配（PSM）将出血后14天内接受早期VCE检查的患者（早期组，n = 678）与未接受早期VCE检查的患者（晚期组，n = 319）进行匹配。然后，我们比较了PSM前后两组患者在1年内初次VCE检查结果为阴性的患者中VCE诊断率和VCE后再出血的发生率。
PSM后，早期VCE与OGIB诊断率显著更高相关（56.4%对45.5%，P = 0.001），且与治疗后1年内再出血发生率显著更低相关（24.7%对36.7%，P = 0.041）。在单因素和多因素分析中，发现VCE检查时机（优势比分别为0.648；95%置信区间0.496 - 0.847，P = 0.001和优势比0.666；95%置信区间0.496 - 0.894，P = 0.007）与更高的阳性发现率相关。
早期VCE可提高OGIB诊断的可靠性，同时降低VCE后再出血率。这表明及时准确的诊断有助于改善OGIB患者的治疗和预后。
