Ibach M B, Grier J F, Goldman D E, LaFontaine S, Gholson C F
Department of Medicine, Louisiana State University Medical Center, Shreveport 71130, USA.
Dig Dis Sci. 1995 Jul;40(7):1459-62. doi: 10.1007/BF02285192.
Proper evaluation of patients with melena and nondiagnostic esophagogastroduodenoscopy is comparatively undefined. We sought to determine the percentage of patients with melena and nondiagnostic upper endoscopy and assess the yield of further evaluation. Of 209 patients presenting with melena, 180 underwent esophagogastroduodenoscopy as the initial study, which was nondiagnostic in 43 cases (24%). Further evaluation was pursued in 30. A presumed source of melena was found in 11 patients (37%), identified by colonoscopy in seven, bleeding scan in three, and barium enema plus flexible sigmoidoscopy in one. Nearly all such defined cases originated from the right colon. Small bowel contrast studies, flexible sigmoidoscopy of barium enema alone, and angiography failed to reveal a source. Our findings suggest that many (24%) patients presenting with melena will have nondiagnostic upper endoscopy; further evaluation reveals a potential source in 37% of this group, with the right colon being the most likely location of pathology; and colonoscopy is the test of choice in this cohort.
对于出现黑便且食管胃十二指肠镜检查无诊断结果的患者，目前尚无确切的评估方法。我们试图确定出现黑便且上消化道内镜检查无诊断结果的患者比例，并评估进一步检查的诊断率。在209例出现黑便的患者中，180例接受了食管胃十二指肠镜检查作为初始检查，其中43例（24%）检查结果无诊断意义。30例患者接受了进一步检查。11例患者（37%）找到了黑便的可能来源，其中7例通过结肠镜检查确诊，3例通过出血扫描确诊，1例通过钡剂灌肠加乙状结肠镜检查确诊。几乎所有这些明确的病例都起源于右半结肠。小肠造影、单纯钡剂灌肠乙状结肠镜检查和血管造影均未发现出血来源。我们的研究结果表明，许多（24%）出现黑便的患者上消化道内镜检查无诊断意义；进一步检查发现，该组患者中有37%存在潜在出血来源，其中右半结肠是最可能的病变部位；结肠镜检查是该队列的首选检查方法。
