Lewis B
Department of Medicine, Mount Sinai Medical Center, New York, NY.
Mt Sinai J Med. 1993 May;60(3):200-8.
I want to convey the notion that enteroscopy has opened many doors, and continues to open up more doors, in understanding and diagnosing diseases of the small intestine. The true nature of small-bowel angiodysplasia is still unanswered. It seems unlikely that the lesions in the small bowel are similar to the lesions that Scott Boley talks about in the right colon. I doubt that the intermittent obstruction to venous outflow, theorized in the colon, is the pathophysiologic change in the small intestine. Those studies, trying to look for the changes that Boley described, need to be done. We are trying to better characterize angiodysplasia of the small intestine, understanding where they occur, with how many lesions, and whether they are associated with any other illnesses. We are looking at the association of small-bowel vascular lesions with lesions in the stomach and colon. Enteroscopy will in the future, we hope, answer these questions. Enteroscopy, especially push enteroscopy, can help us with the treatment of angiodysplasias. We are now evaluating new instruments that reach not just two feet beyond the ligament of Treitz, but the entire jejunum, reaching 6 feet beyond the ligament of Treitz (16). Enteroscopy facilitates clinical research, can be used in patient care, and guides treatment.
我想表达这样一种观点，即小肠镜检查在理解和诊断小肠疾病方面已经打开了许多扇门，并且还在继续打开更多的门。小肠血管发育异常的真正本质仍然没有答案。小肠中的病变似乎不太可能与斯科特·博利所描述的右半结肠病变相似。我怀疑结肠中推测的静脉流出间歇性阻塞是否是小肠的病理生理变化。那些试图寻找博利所描述变化的研究需要进行。我们正在努力更好地描述小肠血管发育异常的特征，了解它们发生的位置、病变数量，以及它们是否与任何其他疾病有关。我们正在研究小肠血管病变与胃和结肠病变之间的关联。我们希望小肠镜检查将来能回答这些问题。小肠镜检查，尤其是推进式小肠镜检查，可以帮助我们治疗血管发育异常。我们现在正在评估新的器械，这些器械不仅能到达屈氏韧带两英尺以外的地方，还能到达整个空肠，延伸到屈氏韧带六英尺以外（16）。小肠镜检查有助于临床研究，可用于患者护理，并指导治疗。
