Chong J, Tagle M, Barkin J S, Reiner D K
Division of Gastroenterology, University of Miami, School of Medicine/Mt. Sinai Medical Center, Florida.
Am J Gastroenterol. 1994 Dec;89(12):2143-6.
Endoscopic investigation of the small intestine remains the last frontier for gastroendoscopists. We evaluated the diagnostic efficacy and safety of two different push-type, fiberoptic enteroscopes in the investigation of patients with occult gastrointestinal bleeding or suspected small bowel pathology.
Sixty-six patients (28 men, 38 women; mean age, 68) underwent push-type enteroscopy with either the SIF 10.5L (n = 17; scope length, 2495 mm) or the SIF 3000 (n = 49; length, 2995 mm) enteroscopes (Olympus America, Inc., Lake Success, New York). All patients enrolled had an indication of either occult gastrointestinal bleeding (n = 55) or suspected small bowel pathology (n = 11). Push-type enteroscopy was performed with an overtube and fluoroscopic guidance to better estimate the degree of insertion. Assessments of mucosal visualization, tip deflection, procedure tolerance, and complications were noted.
Visualization of the small bowel mucosa and tip deflection was rated excellent in all patients. The mean length of insertion past the ligament of Treitz for the SIF 10.5L was 90 cm and 113 cm for the SIF 3000. Only one complication, a pharyngeal tear, occurred with the SIF 3000. Lesions that may explain the occult GI bleeding were found in 35 out of 55 patients (64%). Twenty-one of these 35 patients (60%) had lesions proximal to the ligament of Treitz, and 14 patients (40%) had lesions distal to the ligament of Treitz. If only distal lesions were considered, the diagnostic yield was 25% (14/55) for occult GI bleeding and 73% (8/11) for suspected small bowel pathology. The most common lesions were arteriovenous malformations (34%), which were successfully cauterized.
With a relatively high diagnostic yield and therapeutic capability, push-type enteroscopy should play an important role in the investigation and treatment of lesions causing occult GI bleeding and small bowel pathology.
小肠的内镜检查仍是胃肠内镜医师的最后一个前沿领域。我们评估了两种不同的推送式纤维小肠镜在隐匿性胃肠道出血或疑似小肠病变患者检查中的诊断效能和安全性。
66例患者（28例男性，38例女性；平均年龄68岁）接受了使用SIF 10.5L（n = 17；镜身长度2495 mm）或SIF 3000（n = 49；长度2995 mm）小肠镜（奥林巴斯美国公司，纽约州大颈市）的推送式小肠镜检查。所有纳入的患者均有隐匿性胃肠道出血（n = 55）或疑似小肠病变（n = 11）的指征。在外套管和荧光透视引导下进行推送式小肠镜检查，以更好地估计插入深度。记录黏膜观察情况、尖端弯曲度、操作耐受性和并发症。
所有患者小肠黏膜观察和尖端弯曲度评分均为优秀。SIF 10.5L通过Treitz韧带后的平均插入长度为90 cm，SIF 3000为113 cm。仅在使用SIF 3000时发生了1例并发症，即咽部撕裂。55例患者中有35例（64%）发现了可能解释隐匿性胃肠道出血的病变。这35例患者中有21例（60%）病变位于Treitz韧带近端，14例（40%）病变位于Treitz韧带远端。若仅考虑远端病变，隐匿性胃肠道出血的诊断率为25%（14/55），疑似小肠病变的诊断率为73%（8/11）。最常见的病变是动静脉畸形（34%），均成功进行了烧灼治疗。
推送式小肠镜具有较高的诊断率和治疗能力，应在隐匿性胃肠道出血和小肠病变的检查及治疗中发挥重要作用。
