Papaefthymiou Apostolis, Ramai Daryl, Maida Marcello, Tziatzios Georgios, Viesca Michael Fernandez Y, Papanikolaou Ioannis, Paraskeva Konstantina, Triantafyllou Konstantinos, Repici Alessandro, Hassan Cesare, Binda Cecilia, Beyna Torsten, Facciorusso Antonio, Arvanitakis Marianna, Gkolfakis Paraskevas
Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, UK; First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Macedonia, Greece.
Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA.
Gastrointest Endosc. 2023 May;97(5):849-858.e5. doi: 10.1016/j.gie.2023.01.048. Epub 2023 Feb 2.
The introduction of motorized spiral enteroscopy (mSE) into clinical practice holds diagnostic and therapeutic potential for small-bowel investigations. This systematic review and meta-analysis aims to evaluate the performance of this modality in diagnosing and treating small-bowel lesions.
A systematic search of MEDLINE, Cochrane, and ClinicalTrials.gov databases were performed through September 2022. The primary outcome was diagnostic success, defined as the identification of a lesion relative to the indication. Secondary outcomes were successful therapeutic manipulation, total enteroscopy rate (examination from the duodenojejunal flexion to the cecum), technical success (passage from the ligament of Treitz or ileocecal valve for anterograde and retrograde approach, respectively), and adverse event rates. We performed meta-analyses using a random-effects model, and the results are reported as percentages with 95% confidence intervals (CIs).
From 2016 to 2022, 9 studies (959 patients; 42% women; mean age >45 years; 474 patients [49.4%] investigated for mid-GI bleeding/anemia) were considered eligible and included in analysis. The diagnostic success rate of mSE was 78% (95% CI, 72-84; I = 78.3%). Considering secondary outcomes, total enteroscopy was attempted in 460 cases and completed with a rate of 51% (95% CI, 30-72; I = 96.2%), whereas therapeutic interventions were successful in 98% of cases (95% CI, 96-100; I = 79.8%) where attempted. Technical success rates were 96% (95% CI, 94-97; I = 1.5%) for anterograde and 97% (95% CI, 94-100; I = 38.6%) for retrograde approaches, respectively. Finally, the incidence of adverse events was 17% (95% CI, 13-21; I = 65.1%), albeit most were minor adverse events (16%; 95% CI, 11-20; I = 67.2%) versus major adverse events (1%; 95% CI, 0-1; I = 0%).
mSE provides high rates of diagnostic and therapeutic success with a low prevalence of severe adverse events.
将电动螺旋式小肠镜检查（mSE）引入临床实践对小肠检查具有诊断和治疗潜力。本系统评价和荟萃分析旨在评估该检查方式在诊断和治疗小肠病变方面的性能。
截至2022年9月，对MEDLINE、Cochrane和ClinicalTrials.gov数据库进行了系统检索。主要结局为诊断成功率，定义为相对于检查指征而言病变的识别情况。次要结局包括治疗操作成功、全小肠镜检查率（从十二指肠空肠曲至盲肠的检查）、技术成功率（分别从前向和后向途径通过Treitz韧带或回盲瓣）以及不良事件发生率。我们使用随机效应模型进行荟萃分析，结果以百分比及95%置信区间（CI）表示。
2016年至2022年期间，9项研究（959例患者；42%为女性；平均年龄>45岁；474例患者[49.4%]因中消化道出血/贫血接受检查）被认为符合纳入标准并纳入分析。mSE的诊断成功率为78%（95%CI，72 - 84；I² = 78.3%）。考虑次要结局，460例尝试进行全小肠镜检查，完成率为51%（95%CI，30 - 72；I² = 96.2%），而治疗干预在尝试的病例中有98%成功（95%CI，96 - 100；I² = 79.8%）。前向途径的技术成功率为96%（95%CI，94 - 97；I² = 1.5%），后向途径为97%（95%CI，94 - 100；I² = 38.6%）。最后，不良事件发生率为17%（95%CI，13 - 21；I² = 65.1%），不过大多数为轻微不良事件（16%；95%CI，11 - 20；I² = 67.2%），严重不良事件发生率为（1%；95%CI，0 - 1；I² = 0%）。
mSE具有较高的诊断和治疗成功率，严重不良事件发生率较低。
