Kim Won Shik, Lee Beom Jae, Joo Moon Kyung, Kim Seung Han, Park Jong-Jae
Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine/Korea University Guro Hospital, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
Surg Endosc. 2025 Mar;39(3):2044-2051. doi: 10.1007/s00464-025-11581-z. Epub 2025 Jan 31.
Adult small-bowel intussusception (ASI) is a rare condition with pathological etiologies in most patients. Previously, surgical intervention was the primary treatment modality; however, the introduction of balloon-assisted enteroscopy (BAE) has allowed preoperative BAE in some cases to confirm the leading point, thereby guiding management and reducing surgical need. In this study, we investigated whether the introduction of BAE has altered the diagnostic and therapeutic strategies for ASI by retrospectively analyzing and comparing the clinicopathological features of patients before and after its introduction.
Fifty-three patients with ASI, initially diagnosed via abdominal computed tomography scanning at Korea University Guro Hospital from 2000 to 2023, were included in our study. Patients were grouped based on double-balloon enteroscopy (DBE) usage, and clinicopathological outcomes were compared retrospectively.
Of the 53 patients, 38 (71.7%) had enteroenteric-type intussusception and 15 (28.3%) had enterocolic-type intussusception. Among the patients with enteroenteric-type intussusception, 15.8% had a malignant cause, whereas in the enterocolic type, 60% had a malignant cause (p = 0.001). Of 38 patients with enteroenteric ASI, 15 (39.5%) underwent preoperative DBE. The surgical resection rate was significantly lower in the DBE group (40%) than in the non-DBE group (73.9%) (p = 0.037). Pathological diagnoses of patients who underwent surgical resection without preoperative DBE revealed 17.6% malignancies and 82.4% benign causes, including idiopathic intussusception (four cases) and Peutz-Jeghers syndrome (two cases). No morbidity, mortality, or recurrence was observed.
Preoperative BAE is a valuable diagnostic and therapeutic modality for ASI, particularly in cases of low-grade small-bowel obstruction, reducing surgical resection rates in most ASI cases. The introduction of the BAE has significantly improved ASI management, achieving high successful reduction rates and few surgical interventions. BAE should be considered a first-line diagnostic and therapeutic tool for ASI management.
成人小肠套叠（ASI）是一种罕见疾病，大多数患者存在病理性病因。以前，手术干预是主要的治疗方式；然而，气囊辅助肠镜检查（BAE）的引入使得在某些情况下可在术前进行BAE以确认套叠起始点，从而指导治疗并减少手术需求。在本研究中，我们通过回顾性分析和比较BAE引入前后患者的临床病理特征，调查BAE的引入是否改变了ASI的诊断和治疗策略。
纳入2000年至2023年在韩国大学古罗医院最初通过腹部计算机断层扫描诊断为ASI的53例患者。根据是否使用双气囊肠镜检查（DBE）对患者进行分组，并对临床病理结果进行回顾性比较。
53例患者中，38例（71.7%）为小肠-小肠型套叠，15例（28.3%）为小肠-结肠型套叠。在小肠-小肠型套叠患者中，15.8%有恶性病因，而在小肠-结肠型套叠患者中，60%有恶性病因（p = 0.001）。38例小肠-小肠型ASI患者中，15例（39.5%）接受了术前DBE。DBE组的手术切除率（40%）显著低于非DBE组（73.9%）（p = 0.037）。未进行术前DBE而接受手术切除的患者的病理诊断显示，17.6%为恶性肿瘤，82.4%为良性病因，包括特发性套叠（4例）和黑斑息肉综合征（2例）。未观察到并发症、死亡率或复发情况。
术前BAE是ASI的一种有价值的诊断和治疗方式，特别是在低度小肠梗阻的情况下，可降低大多数ASI病例的手术切除率。BAE的引入显著改善了ASI的治疗，实现了高成功率的复位且手术干预较少。BAE应被视为ASI治疗的一线诊断和治疗工具。
