Cappell M S
Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Dig Dis. 1996 Jul-Aug;14(4):228-44. doi: 10.1159/000171555.
In America more than 100,000 high-risk patients/year have conditions normally evaluated by gastrointestinal endoscopy. This review analyzes the safety and efficacy of gastrointestinal endoscopy in high-risk patients. Endoscopy during pregnancy raises the unique issue of fetal safety. The safety of esophagogastroduodenoscopy (EGD) during pregnancy has been examined in a case-controlled study of 83 patients, a mailed survey of 73 patients, and case reports. The safety of sigmoidoscopy during pregnancy has been examined in a case-controlled study of 45 patients, a mailed survey of 26 patients, and case reports. These studies suggest that EGD and sigmoidoscopy are not contraindicated during pregnancy. For example, EGD should be performed for significant upper gastrointestinal bleeding. The safety of colonoscopy during pregnancy is inadequately analyzed. In a study of 34 EGDs performed within 3 weeks of myocardial infarction, no endoscopic complications occurred in 26 clinically stable patients with uncomplicated myocardial infarction. However, 3 major endoscopic complications occurred in 8 clinically unstable patients. In a study of 9 sigmoidoscopies within 3 weeks of myocardial infarction, no sigmoidoscopic complications occurred in 7 clinically stable patients. Several studies have shown that EGD, sigmoidoscopy, or colonoscopy is safe in patients with advanced HIV infection. AIDS patients should generally be endoscoped with the same aggressiveness as other patients. However, endoscopy may be unwise in any terminal patient. No complication occurred in 60 patients undergoing EGD within 3 weeks of esophageal, gastric, or duodenal surgery. One minor complication occurred in 36 patients undergoing sigmoidoscopy within 3 weeks of colonic surgery. These results suggest that EGD or sigmoidoscopy is not contraindicated within 3 weeks of gastrointestinal surgery. No complications occurred in 53 chronic obstructive pulmonary disease patients undergoing EGD. EGD appears to be safe in chronic obstructive pulmonary disease patients without severe hypoxemia or acute bronchospasm. Emergency EGD can be performed in patients with severe hypoxemia after endotracheal intubation.
在美国，每年有超过10万名高危患者患有通常需通过胃肠内镜检查来评估的疾病。本综述分析了胃肠内镜检查在高危患者中的安全性和有效性。孕期进行内镜检查引发了胎儿安全这一独特问题。一项针对83例患者的病例对照研究、一项对73例患者的邮寄调查以及病例报告对孕期食管胃十二指肠镜检查（EGD）的安全性进行了研究。一项针对45例患者的病例对照研究、一项对26例患者的邮寄调查以及病例报告对孕期乙状结肠镜检查的安全性进行了研究。这些研究表明，孕期进行EGD和乙状结肠镜检查并非禁忌。例如，对于严重的上消化道出血应进行EGD检查。孕期结肠镜检查的安全性分析尚不充分。在一项对心肌梗死后3周内进行的34例EGD检查的研究中，26例临床稳定且无并发症的心肌梗死患者未发生内镜并发症。然而，8例临床不稳定的患者发生了3例严重的内镜并发症。在一项对心肌梗死后3周内进行的9例乙状结肠镜检查的研究中，7例临床稳定的患者未发生乙状结肠镜检查并发症。多项研究表明，EGD、乙状结肠镜检查或结肠镜检查在晚期HIV感染患者中是安全的。艾滋病患者一般应与其他患者一样积极地接受内镜检查。然而，对任何终末期患者进行内镜检查可能并不明智。60例在食管、胃或十二指肠手术后3周内接受EGD检查的患者未发生并发症。36例在结肠手术后3周内接受乙状结肠镜检查的患者发生了1例轻微并发症。这些结果表明，在胃肠手术后3周内进行EGD或乙状结肠镜检查并非禁忌。53例慢性阻塞性肺疾病患者接受EGD检查未发生并发症。在无严重低氧血症或急性支气管痉挛的慢性阻塞性肺疾病患者中，EGD似乎是安全的。对于气管插管后出现严重低氧血症的患者可进行急诊EGD检查。
