Mohan Nandakumar, Jarrett Simone, Pop Alexander, Rodriguez Daniel, Dudnick Robert
Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States.
Division of Gastrointestinal Diseases and Hepatology, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, United States.
World J Gastrointest Pharmacol Ther. 2022 Nov 5;13(6):88-95. doi: 10.4292/wjgpt.v13.i6.88.
Obscure small bowel bleeding is defined as gastrointestinal bleeding (GIB) that is unidentifiable with esophagogastroduodenoscopy and a colonoscopy with video capsule endoscopy (VCE) being the next gold standard step for evaluation. Small bowel transit time (SBTT) is a metric of a VCE study that is defined as the time the capsule takes to travel through the small intestine.
To determine if SBTT within the VCE study, correlates to overall detection of obscure small bowel bleeds. Furthermore, we attempted to identify any existing correlation between SBTT and re-bleeding after a negative VCE study.
This is a single center retrospective analysis of VCE studies performed for overt and occult GIB at Einstein Medical Center, Philadelphia, between 2015 and 2019. Inclusion criteria primarily consisted of patients 18 years or older who had a VCE study done as part of the workup for a GIB. Patients with incomplete VCEs, poor preparation, or with less than 6 mo of follow up were excluded. A re-bleeding event was defined either as overt or occult within a 6-mo timeframe. Overt re-bleeding was defined as Visible melena or hematochezia with > 2 gm/dL drop in hemoglobin defined an overt re-bleeding event; whereas an unexplained > 2 gm/dL drop in hemoglobin with no visible bleeding defined an occult re-bleed.
Results indicated that there was a significant and positive point biserial correlation between SBTT of 220 min and detection of a bleeding focus with a statistically significant p value of 0.008. However, the area under the curve was negligible when trying to identify a threshold time for SBTT to discriminate between risk of re-bleeding events after a negative VCE.
In terms of SBTT and association with accuracy of VCE finding a bleeding focus, 220 min was found to be adequate transit time to accurately find a bleeding focus, when present. It was found that no threshold SBTT could be identified to help predict re-bleeding after a negative VCE.
不明原因小肠出血被定义为经食管胃十二指肠镜检查无法明确病因的胃肠道出血（GIB），而视频胶囊内镜检查（VCE）是下一步评估的金标准。小肠传输时间（SBTT）是VCE检查的一项指标，定义为胶囊通过小肠所需的时间。
确定VCE检查中的SBTT是否与不明原因小肠出血的总体检出率相关。此外，我们试图确定SBTT与VCE检查结果为阴性后的再出血之间是否存在相关性。
这是一项对2015年至2019年期间在费城爱因斯坦医疗中心进行的显性和隐匿性GIB的VCE检查进行的单中心回顾性分析。纳入标准主要包括18岁及以上因GIB检查而进行VCE检查的患者。VCE检查不完整、准备不佳或随访时间少于6个月的患者被排除。再出血事件定义为在6个月时间范围内的显性或隐匿性出血。显性再出血定义为可见黑便或便血，血红蛋白下降>2 g/dL定义为显性再出血事件；而无可见出血但血红蛋白原因不明下降>2 g/dL定义为隐匿性再出血。
结果表明，220分钟的SBTT与出血灶的检出之间存在显著的正点二列相关性，统计学显著p值为0.008。然而，在试图确定SBTT的阈值时间以区分VCE检查结果为阴性后的再出血风险时，曲线下面积可忽略不计。
就SBTT与VCE发现出血灶的准确性之间的关联而言，发现220分钟是准确发现出血灶（如果存在）的足够传输时间。发现无法确定阈值SBTT来帮助预测VCE检查结果为阴性后的再出血。
